Wavepaths Conversations —  Alicia Danforth

Mendel talked with clinical psychologist, psychedelic researcher and Wavepaths advisor, Alicia Danforth, about the transformative potential of psychedelic-assisted psychotherapy, neurodiversity paradigms in psychotherapy and adaptive music, and more.

What is your first personal memory of music?

I'm one of those people who have very good memory of early childhood. When I was tiny, I had a teddy bear that had a music box embedded inside and you could wind a key in its back. I would hold it when I took  a nap. Therefore, my earliest memories of music are associated with comfort, rest, and being nurtured. I realise that music often served as a sort of catalyst in some of my key developmental milestones. I think I first started individuating from my parents the first time I heard “Sgt. Pepper’s Lonely Hearts Club Band” by the Beatles. My older cousins gave me the album, and the first time I listened to it, something in me that was my own self coming forward was engaged. I just loved it. That sense of healthy rebellion: " I'm unlike my parents, and I'm going to start going my own way". That agency got reinforced around the age of 15 when I started listening to Pink Floyd's "The Wall" every night. It was a tremendous source of hope, that I could rebel against certain institutions and forge my own path. It was a great motivator for me. I think about when I was newly divorced - I didn't want to eat, I didn't want to socialise, I didn't want to do much of anything but listen to very loud music and have it hit my body, dance a bit, and move to music to feel alive. Often, music has been the lifeboat that I've clung to, to get through some of the hardest times in my life. Of course, music has been there for the happiest times, too.

So music has been almost like a constant source of support and emotional expression, to such a degree that it became a part of all these pivotal moments in your personal development over time.

Absolutely. Sometimes it felt like something that was actually sustaining me, like food or water. Sometimes it felt like something that gave me a push or shove towards doing something that might take a little courage, in the same way armies going into battle use drums and blaring trumpets. It's also facilitated growth from one stage of development to another at times of my life when it was time to forge a new identity as someone who's independent, or falling in love, or grieving - music has created a portal to move through both very positive transitions, and the challenging ones.

[Music] also facilitated growth from one stage of development to another at times of my life when it was time to forge a new identity as someone who's independent, or falling in love, or grieving - music has created a portal to move through both very positive transitions, and the challenging ones.

What made you decide to become a psychotherapist? What were your key drivers on that front?

Like a lot of people in this profession, I can look back and realise that I was often the friend amongst my friends who people would come to, to get some support when they were struggling emotionally. I came by it naturally. It's no secret that I'm a big talker, but when I'm with somebody who really needs me to hold space and show up for them, I can drop in to deep, deep listening for a sustained period of time, and that really came out when I started doing harm reduction, at Burning Man and other festivals. I naturally gravitated toward providing peer-counselling-type support for people who are having challenging experiences with altered states of consciousness. That work is what led me to begin volunteering in psychedelic-assisted therapy research, before I had any formal training as a clinician. To answer your question specifically, the work that I did, sitting for participants in the pilot study of psilocybin-assisted therapy for anxiety reactive to late-stage cancer, is when I realised I wanted to commit to becoming a licensed mental health professional. Witnessing the profound transformations that study participants were able to make when they were very near the end of life, that inspired me to become a psychologist.

So the interest in the therapeutic potential of psychedelics, your experience with harm reduction and then becoming a therapist were very heavily intertwined. 

I did it backwards. I started doing the research and then realised, when I observed the outcomes, that this approach to treatment could become a legitimate field and that it was likely to take off because it had the potential to be so effective. I wanted to have the credentials to be able to do the work at a more formal level. 

You mentioned this transformative potential of psychedelics. It's clear that psychedelics have that transformative potential for people, given the right conditions are at hand and provided, but there's also potentially transformative potential for how we define mental health and think about mental health. What does the term mental health mean for you?

Mental health is such a big concept and there are so many different formal definitions and systems, but the one word that I keep coming back to when I ask myself that question is "balance". When I consider the various models that we use in psychology, I’m reminded of how they're often spoken about in three parts: bio/psycho/social, cognitions/emotions/behaviours, mind/body/spirit. There's frequently a triad, like it takes three legs to make a table stand. In thinking about mental health as it relates to music, mental health can be compared to a three-part harmony, where different aspects of a person’s internal and external lives come into balance. I'm influenced right now by Dick Schwartz's internal family system (IFS) approach to providing psychotherapy because I just started my training in IFS therapy. When I saw colleagues in clinical trials with psychedelics using IFS so successfully, I realised this can be a fantastic match for this kind of work. It's about helping the internal parts of oneself come into harmony with each other like a healthy family.

Why do you think that is a good match for psychedelic-assisted therapy?

I was a little taken aback, but not too surprised, when they included a brief clip of Michael and Annie Mithoefer providing an MDMA-assisted therapy session in the IFS training, The study participant with post-traumatic stress disorder (PTSD) under the influence of MDMA began talking about different parts of themselves. Their statements were similar to the way people speak when they're in other psychedelic states; they often will get more clarity about different parts, which parts are protecting or wounded, that's how people will start speaking. “A part of me is feeling something”, or “a part of me is doing something”, or “that's not the real me”. It sort of organically comes up in sessions where people start negotiating and reaching out to and calling in parts of themselves to bring back a sense of that balance, harmony and wholeness. IFS gives the therapist a tool to help work with someone in that way. Psychedelics can facilitate even more openness to this type of exploration for some people.

In a way that is very hard in a normal state of consciousness. In psychotherapy, if one person is open enough to explore that, you can get into that.

I don't remember where I heard it, but a long time ago, I heard one of the elder luminaries describing the effects of LSD on the mind as being analogous to moving down a corridor in a hotel, and just opening all the doors and then running away. I think psychedelics serve a function kind of like a key in that way of opening the doors to rooms that might otherwise be locked, and allowing the parts to emerge and interact along with all sorts of helpful symbols and imagery and so on. 

I think psychedelics serve a function kind of like a key in that way of opening the doors to rooms that might otherwise be locked, and allowing the parts to emerge and interact along with all sorts of helpful symbols and imagery and so on. 

So returning to the IFS theory and applying it to psychedelic therapy, and the definition of mental health in essence, being in harmony with these different parts of oneself. I can imagine that in practice, if you suddenly give voice to a part of oneself that hasn't been heard for a very long time, it can lead to a moment of chaos.

Depends on the part!

That's a good point, it can also lead to serenity and beauty and all sorts of other very positive parts of oneself that have been suppressed for a long time or not been available for a long time.

Oh, yeah. It provides access to a whole smorgasbord of the experiences of being human.

You are now in your own clinical practice doing non-drug therapy. Do you feel your work with psychedelic therapy research has changed your work as a psychotherapist? And if so, how?

That's a big question. Yes, absolutely. I think in one way, working with individuals in those more extreme states while they're experiencing the effects of a psychedelic has allowed me to normalise the whole breadth of human experience so that my clients can really feel when they're sitting with me that I can maintain a very non-judgmental stance. That I'm very comfortable with the weirdness and strangeness of the human experience. Often, I think my clients can tell when they're going to share something and they're afraid that I might judge them in ways that others have judged them for being weird or strange or abnormal. It's almost unspoken that I embrace the abnormal aspects of human experience. So it's very difficult to shock me after having sat through some of the extraordinary and often, frankly, weird things that happen in psychedelic sessions!

And are in a way part of our human nature, one might argue. These extreme emotions that need to be vented in constructive ways, they're there for a reason. I was curious about your view on the significant oversights in mental healthcare and how psychedelic therapy addresses them. There is this view emerging in my mind listening to you of psychedelics allowing a more accepting, holistic, integrative relationship with oneself.

I'm influenced by my specialty in working with autistic adults. I think one of the healthiest new paradigms to emerge is the neurodiversity paradigm. It starts with a very basic premise that human brains and minds are different. From there, we can step away from the notion that the goal of mental health care is to help everybody find their way to “normal”. The majority of my clients have been wounded by therapists who were trying to fit an atypical cognitive neurotype into a mould that wasn’t healthy for them. So I think that positive trends in mental health going forward are going to be more individualised. I appreciate the value of highly manualised approaches and the extreme emphasis on evidence-based practices. However, those priorities have had an unintended consequence, in my opinion, of invalidating other useful approaches to mental health care simply because they haven't been studied and published in the same way. I think moving away from one-size-fits-all models is essential. In a very simplistic way, I approach each new client with a grounding in basic questions that I ask myself: "How does this person’s system function optionally?” and “What are the tools that they need and want in their toolkit?" I respect the concern that things are going to get out of control and too eclectic if they aren't grounded in a theoretical orientation and if “anything goes” in therapy. I think we’re still trying to find an elusive sweet spot between science and art in psychotherapy, and psychedelic-assisted therapy might provide a fresh path to get there. 

One of the therapists that my thinking is influenced by is the hypnotherapist, Milton H. Erickson. In one of his books, there's this sentence that states, quite boldly: "For every single patient that enters my room, I reinvent a complete new protocol." Therefore, there is no protocol, but a complete new way of relating with that person.

I have to do the same because my clients are such a heterogeneous population. But that's not to say I still don't ground in a theoretical model. I still have a theoretical orientation and I can bring plenty of structure and evidence-based practices into my work. But if I were to adhere to very rigid treatment plans, I would be at more risk of doing harm for my clients. I would miss deeply listening to what they needed.

I guess this is really what the massive interest in psychedelic therapy right now is causing as a challenge, as a problem, is how do we operationalise this very complex and new form of therapy? Because, we have not pharmacotherapy, not psychotherapy, but a method that demands the therapists and facilitators to be able to work with altered states of consciousness and sometimes very extreme experiences, and having a fully individualised approach is quite radically different than cognitive behavioural therapy (CBT) for example, where you have a manual and a decision tree that you can follow. This is a very important question, “what are the qualities of the future psychedelic therapists, and what kind of training would they ideally need to undergo?” 

It's no coincidence that the seed of strong interest in psychedelic psychotherapy found fertile ground in the humanistic and transpersonal movements. I’m reminded of the gifts of innovators such as  Carl Rogers, and Eugene Gendlin, who had the ego strength to acknowledge, "I'm not the expert on you, you are. So, I'm going to follow your lead”. I know the Mithoefers certainly brought that perspective into their MDMA work through IFS. This notion that there is a Self, a wise guide that already knows that it has a role as a healing presence within. The psychotherapists who are a good match for providing psychedelic-assisted therapies are the ones who can disengage a bit from their egos, from the role of the all-knowing expert who will lead clients to the solution they need. The skill is tuning into listen to what the participant or client is conveying about what they need on their healing path. It's saying, "I'm hearing what you're needing to go where you want to go and I'll support you on that journey." And that's a tough leap for a lot of mental health professionals to make.

The psychotherapists who are a good match for providing psychedelic-assisted therapies are the ones who can disengage a bit from their egos, from the role of the all-knowing expert who will lead clients to the solution they need. The skill is tuning into listen to what the participant or client is conveying about what they need on their healing path. It's saying, "I'm hearing what you're needing to go where you want to go and I'll support you on that journey." And that's a tough leap for a lot of mental health professionals to make.

And it still is, because it was a long time ago when Gendlin and Rogers made this very “radical” idea that maybe we should listen to our clients! 

It's much easier said than done! 

I've noticed that often people tend to build this caricature of Rogers just constantly confirming and reflecting back whatever you are saying to him. And in reality he had this really deep idea that there is a part in ourselves that is part of the universe as well, that has a self-organising intelligence behind it towards syntropy. Not entropy, syntropy, completeness. And that is what you're tapping into in a successful psychotherapy session. And that is what is maybe more available in a psychedelic state, where you give voice to these other parts that are not able to be voiced before.

That's consistent with what I've observed.

What we're talking about here, Alicia, is how psychedelic therapy is not necessarily, in my opinion, a complete new form of therapy, but it's integrative. It's an effort to integrate the wisdom that's there. It's out there. There's nothing being invented that is new. The only thing that's new is people being in this more receptive open state for change. 

It's been this way for ages, there's really nothing new under the sun. Humanity just keeps going through these cycles of forgetting. I don't know why, but we do.

So let's talk about psychedelic therapy and music. What was your experience like, selecting music for patients? 

Collaboration around playlists has always been one of my favourite parts of psychedelic research. It's one of the more fun aspects of getting ready for studies. Early on, there was tension around what our guiding principles for including music should be. Is minimising variability the top priority? Under the gold standard of science, does every participant have the same experience with the music, so that the drug effect (if there is one) is more apparent? Otherwise, the study method could be critiqued for combining too many types of therapy. Psychedelic experiences are so subjective, and music can either be a support or work against internal guidance. The carefully curated playlists are so much more than an aesthetic consideration. 

And work against those voices that are actually wanting to speak, like being a different voice.

I remember one year when I was working in the sanctuary at a big festival, we were placed next to a really rough camp, and they were playing angry metal, like speed metal, loudly. It blared all night. And that year was so challenging to provide support for guests having a rough trip. They refused to change the music, and that just made it so much harder to maintain anything close to an ideal setting..

It's like the worst environments to provide support, and it's the worst set and setting if someone is in a crisis. And therefore, a speed-course to become a psychedelic therapist when you think about it.

Yeah, it was very challenging. But back to the music and the playlists. I can share an anecdote with you, that Charles Grob has shared from the psilocybin pilot study with cancer patients. It was a within-subject study design, so everybody got placebo, and everybody got psilocybin - we were blinded as to which session was which. So this participant had already had the first session. Everyone was fairly certain, they didn't know, but their impression was that it was placebo. So they came back to the second session anticipating that this time would be the real thing. For four hours, nothing was happening. And the psychiatric resident who was a fellow on the study, said "I think the music is too mellow", because they were playing very new-agey, ambient music the whole time. And he said, "I think I have a Dead Can Dance CD down in my car", so he ran down to get it and popped it in. In a  short period of time, the floodgates opened and the participant began to sob without sharing in the moment what they were experiencing. They just cried and cried and cried. The two psychiatrists on the study attributed the shift to changing the music. Once the valence and activation levels were adjusted in the music, the catharsis could unfold. Afterwards, when the participant shared what they were experiencing, it was profound. They were processing grief, loss and regret. The experience allowed for self-forgiveness that carried over into daily life for the remainder of the time that they survived. And everyone in the room agreed that the transition in the session was due to switching up the music. The resistance might have held for the entire session without attention to the music match.

So what you're saying is in your experience working in music and psychedelic therapy, music plays a role in almost helping the individual to be authentic and be open. And if the music is chosen wrongly it may do the opposite, it may even enhance resistance. So do you think in this case, there was just such a mismatch in the music and their needs or feeling states? Or do you think it may be the opposite, that the music was just so comforting and okay, that nothing needed to be done and the drug didn't kick in? I know that this is very speculative but it's a very fascinating story, of course, that we have four hours of a strong psychedelic drug being in the blood and not causing psychedelic effects. And I've heard this before, this is definitely not not uncommon, I would argue.

Yes, this happens. I think an individualised approach to the music is essential for psychedelic-assisted therapies. I'm glad that we're stepping away from the era when there was so much concern around conforming rigidly to the scientific method by minimizing variability in the music across sessions. I think we're moving into an era when practitioners recognise the need to individualise the music to a certain extent, because someone who's encountering resistance and difficulty in the coming on period may need an extended amount of time to get over initial anxiety. They might benefit from listening to more soothing, gentle music for a longer period of time. More activating or bittersweet music is usually more appropriate for the peak than when somebody is still in an extended launch. And similarly, if someone is really having an intense, prolonged peak, if you start playing the mellow, grounding return tracks too soon, that can feel disorienting or even result in a sense of not being met. 

I think we're moving into an era when practitioners recognise the need to individualise the music to a certain extent, because someone who's encountering resistance and difficulty in the coming on period may need an extended amount of time to get over initial anxiety.

Not being acknowledged, not being seen.

It can feel like a musical handshake when you really need a musical bear hug.

I wonder what kind of music that would be. 

Well, you’ve heard me say since I first started collaborating with you that I’ve been waiting to hear Wavepaths music that I can feel in my bones, and I finally did in my last music session. My body said: “There it is, they’ve got it. That’s the experience I’ve been waiting to feel!” It’s very embodied. The bass was rattling just enough through my body to allow my psyche to go where it needed to go. No drugs required. 

... I’ve been waiting to hear Wavepaths music that I can feel in my bones, and I finally did in my last music session. My body said: “There it is, they’ve got it. That’s the experience I’ve been waiting to feel!” It’s very embodied. The bass was rattling just enough through my body to allow my psyche to go where it needed to go. No drugs required. 

I love that, it sounds like we succeeded, in one of the many ultimate tests! 

I couldn’t give my stamp of approval until I had that embodied experience that I was waiting for. 

There’s a role for both music that is super soothing and comforting, and there’s a role for music that is deepening and activating emotionality in all sorts of different ways. And as a therapist you want to be able to move in between them, wherever there’s a need for that. 

Yes, you need music along that full range of activation. In the last two studies when I was the “DJ”, I started every session with gentle, repetitive tones, either chimes or singing bowls, waking up the parts of the body that respond to music very gently.  We also had a track in reserve that wasn’t part of the main playlist - for those rare times when a full blast of high activation was appropriate (Example track: Glósóli by Sigur Ros).

This brings me to a fun question. If you were in a therapy session and you were only allowed to play one song, what song would it be?

If all the other music in the world disappeared and I could just grab one track, it would probably be the first track from Brian Eno’s “Music for Airports”. It’s not going to harm anybody, it can evoke so many ranges of emotions, it’s soothing, it’s got just that little pinch of bittersweet that I listen for. It’s not a happy song, it’s not a sad song... 

There’s space for you as a listener to explore and express different… it’s not demanding.

Yeah. And from experience I can tell you, it works in psilocybin sessions and it works in MDMA sessions - it’s kind of the one-size-fits-all song. Definitely for the beginning and the end of the session, I wouldn’t play it during a peak, unless somebody was really needing some help calming down and sort of matching where they were with the music. It’s a cliche, but for a reason. 

What is the biggest obstacle you see in the research and development of psychedelic therapy over the next years?

Getting the therapies to the people who need it the most. 

And why do you say that?

There’s a whole host of reasons. I think persons of colour, and rightfully so, have become guarded and suspicious about what goes on in sanctioned clinical research, so that their needs are largely understudied. Individuals who live in poverty, who can’t afford to go to a psychedelic retreat centre. I think an important barrier to overcome is to make a much better attempt than anything we’re doing now to have a public health model, and I know that some individuals here in the States are working on presenting a case to insurance companies to reimburse for these services. I don’t think it will be that difficult to create a pretty compelling cost-benefit analysis - yes, this is expensive for a very brief period of time, but you’ll save in other mental health costs in the long run investing in this approach upfront. I’m optimistic that the potential benefits will be supported adequately to encourage insurers to cover the costs of psychedelic-assisted therapies. And I think another enormous challenge ahead of us is developing adequate training and supervision of practitioners. 

So making sure that therapists have adequate qualifications and a good ethical framework and a good knowledge framework at hand. 

In addition, ongoing supervision and oversight is going to be essential and it’s going to require new paradigms. I anticipate that there’s going to be a ton of resistance, given the current entrepreneurial zeal carrying over from the cannabis industry. We need the equivalent of a counsel of elders and the tribal structures that oversee shamans. The risk liability is huge, and I see the greater risks coming from the people who provide the care rather than from the substances, or the therapy, itself. So, rigorous supervision and oversight of practitioners beyond basic skills training is going to be essential, and I think there’s going to be a lot of pushback. 

For what reason? 

It’s complex terrain. Mental health professionals are required to safeguard confidentiality and privacy. They are responsible for holding that container. Psychedelics increase suggestibility, and, therefore, attract individuals who sometimes seek to exploit that vulnerability, even in sanctioned clinical settings. Are sessions going to be videotaped in non-research settings? Who is going to view them? Who’s going to be able to peer into the container to make sure that the therapies are being provided in a safe and ethical way? It’s going to be a huge challenge. Similarly, given the recent surge in efforts to decriminalise, how are we going to provide effective protections for safe use in uncontrolled settings? These are some of the enormous logistical challenges ahead of us. 

Finally, what makes you most excited about Wavepaths? 

I’ve been excited about Wavepaths from the start, you know that! We need a flexible, responsive, science-based approach, and you are in a position to ground this new technology in some of the assertions about music and what it’s doing in the brain. I’ve always wished that I had a tool that I could adjust in the moment, to be more spontaneous with the music during sessions. To match the needs of study participants over the course of a journey, to be able to extend a certain valence or activation level for a period of time on the fly, or to be able to stop something that’s not working and smoothly transition to something that feels like a better match. There were many moments - usually invisible to the study participants because they were wearing masks and headphones - when the therapists were fumbling around with the computer to adjust a playlist as seamlessly as possible, but we weren’t always successful. Awkward music transitions can be very jarring in altered states. Just having those lovely, smooth transitions and being able to adjust the music similarly to controlling a thermostat will be so helpful to remaining present and grounded - if I’d only known 15 years ago that something like this was coming down the pipeline... 

We need a flexible, responsive, science-based approach, and [Wavepaths is] in a position to ground this new technology in some of the assertions about music and what it’s doing in the brain.

I like your thermostat metaphor, because this is already what we’re picking up with a small group of therapists that we’re beta-testing with. One of the main things they like is that there’s so much thought being brought into the music, they can trust it. If they want to change it, they can just tap a button, and it changes. It takes away some concern and anxiety, and empowers them to be more present with the patient. 

The type music being composed for Wavepaths is similar to most of the best innovations in the sanctioned, controlled settings in one regard that is often overlooked:  It’s well-informed by conventions of set and setting that have been evolving in the underground for a long time. The music that people naturally gravitate towards in festival settings where they spontaneously have a transcendent or transformative experience, that kind of communal knowledge is finding its way into the music of Wavepaths as well. And yet there’s also a maturity in the music, and there’s a universal appeal of the type of music being created for Wavepaths that I can see being appealing to people across the lifespan.