Psychedelic Psychotherapy with Dr. Michael Sapiro

 Psychedelics have been in the news a lot lately as a new way to help people work through otherwise intractable issues of grief, depression, and PTSD. Dr. Michael Sapiro is a psychedelic psychotherapist and researcher who has worked successfully with psychedelics in his practice for years.

He focuses on helping combat vets and first responders overcome PTSD and other trauma; in his words, transforming worldly warriors into spiritual warriors. Listen to this episode to hear how psychedelic substances, meditation, and Buddhism have helped his patients overcome huge problems and open up to themselves and to the people around them.

[00:01:39] Scott Snibbe: Michael Sapiro, it’s a pleasure to have you on A Skeptic’s Path to Enlightenment. I’m really excited to talk about this topic of psychedelics and their intersection with mental health, Buddhism, and meditation, which I don’t know much about except what I’ve read. I’m going to learn a lot from you.

[00:01:56] Dr. Michael Sapiro: Thank you for having me on the show and I’m looking forward to sharing whatever I can from my experience and what I’ve done in the field.

Michael Sapiro’s background in Buddhism, psychotherapy, and psychedelics

[00:02:04] Scott Snibbe: I wonder if you could just start off by telling us a little bit about your background in Buddhism, psychotherapy, and psychedelics, all about this intersection.

[00:02:13] Dr. Michael Sapiro: I started psychedelics around 15 years old, that led me to Buddhism at around 18. The way it led me there was through some just very concrete, mystical experiences and I say concrete because it was felt and I understood it was something different than I had perceived of the world. Before I did acid and then I perceived the world differently and had a different sense of myself and my sense of connection to the world and universe. Even that young I didn’t know what to do with all of that, no one teaches you at all how to connect to the universe or to your own heart.

It just naturally led to exploring Daoism, exploring mystic traditions, even that early I was interested in mystic poetry and poetry from all over the world. It led me through Daoism to Buddhism and I found a teacher pretty early on in the Zen tradition; although, she had studied in both Tibetan and Zen traditions. This was in college and she held up a Tanka painting and a Zen calligraphy painting; she said, Which are you drawn to? My whole body felt at ease looking at the Enso circle, I just relaxed, and I was not a very relaxed person at the time. So I followed the Zen tradition for about eight years.

Then I went to the Peace Corps in Thailand and asked permission from my Zen teacher to switch lineages to the Theravadan tradition. I started studying under some Thai monks and I learned the language in Peace Corps and then became a monk for a very short time. When I got back to the States, I continued studying and I learned under James Beres who is a teacher at Spirit Rock with Jack Kornfield.

Along that trajectory of Buddhism, I also studied non-duality, non-dual thinking, non-dual philosophy, non-dual meditation, along with Ayurveda, the yoga philosophy. I have a very strong non-dual meditation practice that I use in my psychedelic psychotherapy work. People were coming to me for spiritual help as a yoga teacher, and I couldn’t address all the things—suicide, deep trauma—yoga wasn’t going to solve all that.

I got myself a doctorate in psychology, and it merged those paths together, the paths of spirituality, meditation practice, and psychology, the understanding of how the mind works, beliefs, how culture influences the way we think and act.

Psychedelics have always been there for me, and I’ve been leading groups, on and off, for many years, and leading individuals, and now I get to do that legally through the ketamine clinic I work in, and all of that’s integrated: non-dual ways of being, Buddhist dharma, practice, psychology, and science.

What does it feel like to take psychedelics?

[00:05:13] Scott Snibbe: The reason I’ve never taken psychedelics is because my father really wanted me to when I was a kid. He said I was too into physics and math and that I needed to take LSD as soon as possible to see the reality more clearly. For that reason, of course, I rebelled against my parents and never took psychedelics.

I wonder if you can describe that experience really briefly for me and for people who haven’t taken psychedelics. Your foundational experience wasn’t clinical, it was recreational and mind-opening.

[00:05:43] Dr. Michael Sapiro: I’m writing a book on this topic for the Mayo Clinic press. In the end of 2024, my book should come out, Truth Medicine. It’s how’s psychedelic psychotherapy works in real time with clients and patients, how it unlocks our potential, and right now I feel very in the middle of the writing and it’s a good time to ask that question because I can help explain what really goes on in the psychedelic session.

I’ll start off with a non-scientific and non-clinical view; it helps us explore our own psyche in a very deep way. The layers of our psyche from the conditioning of our parents, our culture, our teachers, you get to see it all very clearly. You can see these imprints of culture, our family, the lineage, and ancestry of our family. You get to see it very clearly through beliefs that we carry, that we are very velcroed to.

Our normal, waking consciousness is most often not aware of the beliefs that are the foundation for the way we are in the world. When you’re in a psychedelic experience, it’s like stepping behind it, above it, looking underneath it; you see yourself from all these perspectives you’ve never saw before. You see the depth of your own psyche, including things that are unconscious, that you have repressed for a long time, experiences you haven’t addressed in your life, beliefs about yourself you have never talked about. You get to see that very clearly in real time.

Our normal, waking consciousness is most often not aware of the beliefs that are the foundation for the way we are in the world. When you’re in a psychedelic experience, it’s like stepping behind it, above it, looking underneath it.

I use the word real time because it’s not like in therapy where you talk about something that has happened or want to happen. In psychedelic psychotherapy, it’s going on in the moment, which is why it’s so profoundly transformational because I can use the material of your own psyche in the very moment it’s coming up whether it’s something you’ve repressed, sublimated, transferred, forgotten, or denied, including our own potential. A lot of people forget they’re creative and they have passions and gifts and a genius in them. Michael Meade says we all have a genius potential, it’s not just for some people, that’s a myth. You see that in real time.

Then you also explore the cosmos, the material of the universe; stars and galaxies appear inside you. Things that make no sense appear inside you, things you could never have imagined. What’s it like to greet something you could never imagine? How do you have a relationship with that, that exists with inside you? That comes from around us. It unlocks parts of us and parts of the world, we are often living in blinders to.

[00:08:43] Scott Snibbe: I think one thing that really struck with me is that you’re saying that the psychedelics can help reveal your conditioning and your bias. We talk about this a lot in Buddhism too, how we think we’re seeing reality, but actually everything is conditioned by our prior experience. In neuroscience and psychology, they also talk about this. You’re utterly conditioned by your upbringing, your language, your race, all of these different things.

 That really struck with me. You’re saying that becomes clear through a psychedelic experience?

[00:09:11] Dr. Michael Sapiro: It can and why I like having a guide or a therapist along is because that person, a guide or a therapist, can help make sense of some of this stuff. It’s really not for me to interpret so much as it is for me to ask really good questions, for them to make sense. It doesn’t always make sense.

We’re not leaving every psychedelic session going, Oh, I understood why that blue dragon was flying over what I thought was the Antarctica of my soul. People say stuff like that all the time. It’s poetic and mythological but what does it mean to them that this is surfacing right now? Sometimes it doesn’t have relevance right then, but something will be sparked later in the week. They’ll remember as a child this thing happened, I was beaten up. I went and hid in my room and I saw this dragon like shadow and I felt secure that this thing was there with me, but they don’t remember that till later.

It makes things that are hidden visible within us and we get to make meaning of that in terms of their healing and growth. As a psychotherapist doing psychedelic work, I’m orienting my work toward healing and growth. What needs healing and where is the growth? All the material that we’re discovering, including that conditioning, is for the benefit of their healing and for how they want to grow in the future.

Is there such a thing as a “bad trip”?

[00:10:36] Scott Snibbe: Obviously not every person who’s taken psychedelics has had a kind of healing, growing, or awakening experience. Of course, some people do this for fun and some people I’m sure also have been harmed.

How do you make the experience beneficial? You talk about guiding and I’ve seen Michael Pollan‘s writings and the series on Netflix where they show how you guide these sessions. How do you create that container so that psychedelics are beneficial instead of just, entertaining or even harmful?

[00:11:05] Dr. Michael Sapiro: This is interesting. A little side note, entertaining can be profoundly healing and growth-oriented. And harm, unless it triggers a schizophrenic episode where that unlocks something that we would wish would have been dormant and that’s unfortunate. There can be, of course, harm done with these medicines.

I don’t actually believe in bad trips. I believe in trips that aren’t understood and that are scary and not supported well. I’ve had them, but I’ve made sense of them even in my own life and even when I heard three different voices and I got scared I would never ever come back to reality. When I was done with that it helped me understand my psyche and I’m talking about 19-year-old dude in college having this scary experience, but I always had the understanding that it’s all within me so I have to understand it. I have to work with it.

I don’t actually believe in bad trips. I believe in trips that aren’t understood and that are scary and not supported well.

That’s why, ironically, I do this as a living now, many decades later. The way I create a container is with the client, we’re collaborating, we are co-creating an experience very intentionally for them to either heal something or grow in a way that they’re longing for. The prep work is extraordinarily important. We spend time together, one, looking for the deepest wounds we can right away. I’m gentle and kind and loving, but I’m extraordinarily direct. That first session, we want to go to the heart of the wound so we know what we’re looking at.

That’s not, I’m drinking a lot or I’m really depressed. That doesn’t mean anything to me. Those are attributes of something much deeper. Before they even come to the clinic we set up a container for safety, trust between them and myself. Then we look, what are your healing intentions? How do you want to grow? I have them look at different domains of psyche, spirituality, physiology, relational, in those domains, how do you want to heal? Then I teach them how to surrender, have trust, be curious during the experience.

We’re setting up the container before they even go and have an experience, preparing them as best as we can. But then you have to let that all go because you have no idea what’s going to happen, what the medicine will do. I also prepare them to have some trust. The preparation I think is just as important as the session and just as important as the integration afterwards. I have a container of letting them know what’s coming and how we’re structuring this.

It’s safety first, mental safety, as well as medical safety. Everybody gets screened. You don’t just come to me and I’m like, Yeah, here, take some drugs. You get screened. Is this appropriate for your body, for your brain? What disorders, diseases do you have? It might not be appropriate for people, and so we want to say no when it’s appropriate to say no.

Firefighters using psychedelic psychotherapy for trauma and more

[00:14:03] Scott Snibbe: Can you talk about one specific example of how psychedelic psychotherapy has worked for somebody while of course respecting confidentiality?

[00:14:10] Dr. Michael Sapiro: I have many stories, I’m writing them in my book with permission from my clients and patients. I have so many really powerful, transformative stories. I work with firefighters, first responders a lot, also combat vets. Although I work with community members too, I tend to focus my work on first responders.

Somebody had come in thinking they were going to address some of the pediatric calls that they go on as a firefighter. Firefighters are first responders, they often are there before police or even ambulance. They’re the first on scene often and if there’s pediatric trauma calls, that’s very difficult for most people to go, even when they’re stoic and they’re trained, it lingers on their consciousness for a very long time.

A lot of firefighters might come in thinking they’re going to be processing some really traumatic calls. What ends up happening is, in the session, an image of their father or their grandfather comes up. Then we start rerouting what we thought we were going to do toward what’s actually present for them, which is the way they were treated by their father or grandfather, the pressure that was put on them to succeed, the pressure that was put on them to compartmentalize feelings.

What comes out was that they feel numb in their lives, they don’t feel connected to themselves, they often feel completely disconnected from other people. Then we start exploring where first did they have to shut themselves down to feel loved. Then we start doing that work. Oftentimes untended grief, will erupt in session for a past parent.

What comes out was that they feel numb in their lives, they don’t feel connected to themselves, they often feel completely disconnected from other people.

One of my very alpha dog kind of first responders came in thinking it was for something else. He spent a lot of time grieving his mother who died when he was 14 and how that changed his life forever. He spent time crying and letting out the grief he was never able to, that he used alcohol to numb himself, which he still does as a 50-some year old man.

These are some examples of what might walk in the door, but what actually happens is the heart and your own consciousness will show what’s most important to you as you’re doing this work. Then my job is to immediately shift, I’m not like, What about that call you wanted to talk about? No, immediately I follow their own intuitive guidance; we start working on that.

Usually this transformational work takes three sessions. It’s unbelievable how fast this works when your own ego is out of the way. When your heart is the one speaking for you and doing the work and when your consciousness shows you what’s important rather than your ego going, this is what I think I want to work on. Your heart and your own consciousness say, no, this is what you need to work on. Then we go right to that and do the work.

Integrating the lessons from psychedelics into daily life

[00:17:16] Scott Snibbe: The short course of treatment is really interesting. Again, from Michael Pollan’s writing and his TV series, I was struck by these “one and done” treatments. Some of them just taking one time to overcome huge problems like trauma, grief, accepting death, and so on.

Is that typical of your patient? How much of what you do continues over many sessions? How much of using psychedelics is this very short course, one to a very small number of treatments?

[00:17:44] Dr. Michael Sapiro: The work is the rest of your life. I want to make that clear. There’s no magic bullet, no magic mushroom that will cure. It’s an opening, it’s a perception change, more importantly, it’s a relationship to yourself through compassion and love that then has to be put into place through integration practices moving forward.

The media has done a great job of bringing attention to what we do. But what it’s done contrary is create a hype that it’s a one and done, and it’s not. That is not what Buddhist practice is about. It’s not what any integration or spiritual practice is about. It’s a continual sustained practice of what you’ve learned.

One metaphor is you jump on a trampoline and you get to see this complete new vista of scenery of the universe or the world, but you ultimately come back down. Jack Kornfield said, after the ecstasy, you’re right back to folding your laundry. How do you integrate ecstasy into folding your laundry?

I have seen profound changes in one session of psilocybin and 5-MeO-DMT, and I have seen profound changes after three sessions of ketamine that then have to be integrated specifically into their lives. Not everything has to change. In fact, smaller changes are better than big changes. But you are getting a transformational shift in worldview and relationship to yourself.

Most people, most of you listening, struggle loving yourself so deeply you have grace and compassion for all the stuff you do. What the shift is when we’re working together, my work is to help them love themselves unconditionally and speak their truths without reservation. At least to me, at least to themselves. If we can do that in one to three sessions, their lives are completely different.

[00:19:36] Scott Snibbe: Then after that, do you continue with normal, non-drug related therapies, or does the person have things that they keep exploring on their own?

[00:19:45] Dr. Michael Sapiro: Right now I’m only seeing first responders generally private therapy. Most of my work is psychedelic psychotherapy and then transformational coaching for other populations like artists and scientists and people who’ve created things and want to unblock some new things. For most people though part of the integration process is finding a therapist.

Some people stick with me as a coach, like I’m coaching them now into thriving. But some people are actually like, Oh, I need therapy now, I never really did it this deeply. Now I’m going to go back to my therapist and take what I’ve learned here and be much more honest with my therapist and myself.

I always recommend people finishing a treatment of ketamine with me to go and engage in therapy or coaching and have a spiritual teacher and have a community of people. To take on a practice like dancing, drumming, art, spinning, yoga, meditation. All of that is a part of the integration, so therapy should be included in that.

[00:20:51] Scott Snibbe: In complex systems, there’s this idea of an attractor. Systems that are very hard to define using ordinary mathematics use the mathematics of chaos. But I’ve always thought that our minds must be like that, that we get stuck in certain loops and then something can knock them out. I was mentioning I was raised without any drugs, I was actually raised a Christian scientist, so we had no drugs at all.

But I had my wisdom teeth out in my 20s and at the time I was, I wouldn’t say depressed, but quite grumpy and miserable. Just not enjoying my time getting a computer science graduate degree. I had my wisdom teeth out and they prescribed me Percocet. I was not going to take it, because I don’t take drugs. But then, as the pain started coming, I asked my girlfriend, Give me those pills.

I had that experience where all of a sudden I was very happy. It’s a strong drug. But after it wore off, I had the kind of experience you’re talking about where I felt my mind is actually much more flexible than I thought and it really is an internal attitude of, I felt so much joy and I felt I could continue that. It’s actually, it’s not an external system. There’s some external factors too, but it’s the process of the mind.

Tell me a little bit more about the idea of drugs enabling this kind of hard reset or a move from one steady state to another in your mind.

[00:22:13] Dr. Michael Sapiro: It’s fairly simple, I think our minds are conditioned for repetition, for survival, homeostasis, a balance, even when it’s unhealthy. Even when it’s an unhealthy habit of mind, it’s conditioned to stay there, and most of us are very scared of changing because it’s very uncomfortable to change out of a system. It disrupts us. A lot in our body too, it’s often uncomfortable physiologically to make even a healthy change. We don’t want that discomfort. We want to go back to baseline.

Even when it’s an unhealthy habit of mind, it’s conditioned to stay there, and most of us are very scared of changing because it’s very uncomfortable to change out of a system.

I think there’s a neurological component of the default mode network that’s working constantly and the drug interrupts that. It shows something beyond, below, around it, inside of what we thought we took for granted that’s reality. We think our outer reality and our inner reality have nothing to do with one another. Then all of a sudden we see, Wow, my inner reality is actually painting outer reality. If my inner reality is shifting, outside looks different. I always hear this after sessions. Things are sparkling and I’m not even high.

The drug’s worn off, the half life of the drug is short, ketamine doesn’t last that long. The next week you still feel good and things are sparkling. It’s because your consciousness has taken on a new quality. No different than in meditation, but boy, I’ve meditated 28 years at this point, or something like that. I’ve done meditations where I have disappeared completely disappeared into the fabric of existence itself.

I’ve done meditations where I have disappeared completely disappeared into the fabric of existence itself.

Then I come back online and I’m like, Oh shit, I’m Mike again. I’m this guy again, I’m stuck in his body and his trauma stuff. I’m like, Oh, I just wish I could be in this big state. Ketamine does that to me, it’s a non-dual state. What we want to do though is actually integrate that into our normal waking lives because Mike is never going to operate without Mike.

I can’t be in a non-dual state and be a psychologist and a lover and a brother and a friend. But I want to take that non-dual state and integrate it and create a different quality of my own mind, which is what we’re doing in the psychedelic state, what the drug is helping us do. Then everything’s a little different for the week after.

Then it becomes a choice. Okay, here’s my old habit. I don’t want that old habit and it’s really hard. You’ve got to shift out of that even minutely, for a moment. Even if you go back to the old habit of mind, you taste it, you smell the incense, it’s still lingering. You’re like, Yeah, but I want this. It does become a choice even in terrible circumstances. I can work with prisoners and inmates who can have a new quality of mind through deep meditation.

That’s what we know. Drugs do that much, much quicker than meditation, so rapidly, and you get the flavor of it: self-love, unconditional love, clarity of mind. Then why wouldn’t you want to go toward that? That’s when the work begins.

The intersection of Buddhist meditation and psychedelic therapy

[00:25:11] Scott Snibbe: One of the reasons I wanted to talk to you is because you have that dual background in Buddhist meditation and the psychedelic therapies.

Can you talk a little bit about how those two things relate? How they’re similar, how they’re different.

[00:25:26] Dr. Michael Sapiro: I always think this about my Buddhism and my non-dual practices, Buddhism is about refining my humanity toward love, kindness, wisdom, insight, compassion, and sympathetic joy. It’s refining Mike’s jagged edges, rounding them out so I could be a healthier version of myself and be kinder and more service oriented toward others. Buddhism has given me that and of course it uses more than meditation to get us there.

Buddhism is about refining my humanity toward love, kindness, wisdom, insight, compassion, and sympathetic joy.

But my Buddhist meditation practice really helped me see how my mind works and how that impacts the way I am in the world. My non-dual meditation dissolves my sense of self, where I’m really a part of the whole picture, where I’m not separated from the cosmos, universe, environment, the earth. I am literally just one essence of life living, just like a tree is living. I don’t get as caught on to all the stuff that’s inside of myself. I really can resolve into being, resolve and rest in being, that’s my non-dual practice.

The psychedelics introduces all of that. It introduces seeing yourself more clearly, where we are prone to hurt others, where we’re prone to hurt ourselves. It also dissolves our boundaries with the universe. So we’re not so caught up in just being a simple complex system contained in bones and blood and skull. We’re actually a part of this big grand mystery of life. Psychedelics is introducing all of the elements that I found in Buddhist practice as well as my non-dual meditation. It’s pretty easy for me to weave that into the work I’m doing.

Buddhism, it takes a while. Of course, you can be slapped into awakening, but you still have to integrate the awakening into your daily life. But Buddhism, from my perspective, is taking my whole lifetime. I am not going to be without fault. But with psychedelics, all of a sudden you’re like Oh, I have this experience and I’m different now. I’m like, No, you’re not, you’re high. You’re not going to be high in two days, so please don’t think this is you now. You’re just high right now. And it feels great. But I always say the high won’t last, but the truth will, and Buddhism is like a long version of truth unfolding itself.

I always say the high won’t last, but the truth will, and Buddhism is like a long version of truth unfolding itself.

The non-dual approach to psychedelic psychotherapy

[00:27:50] Scott Snibbe: You’ve used the term non-dual a few times. In Buddhism, there’s a notion of emptiness or interdependence, dependent arising, that they would say awaken you to the non-duality. I wonder if you can talk about what you mean when you talk about non-duality? You talk about having a non-dual approach to psychedelic psychotherapy. For people unfamiliar with that term, and also even for me—there’s lots of ways of thinking and using that term—what do you mean by that?

[00:28:18] Dr. Michael Sapiro: It’s this and that, here and there, everywhere, all at the same time. One of my favorite movies, Everything, Everywhere, All at Once. That’s a big look at it, it’s not a process, it’s an already existing unfolding. The dual process of spirituality is you start here, you do these practices, and you end there.

Let’s say you’re wanting this thing in your life. You starting here. Here’s the path you do it. And you get off the path on the path of—and then maybe you have an experience of that. The non-dual way of being is an experience of you already contain the thing you’re looking for. You do practice to remind yourself of that. You do practice to have the conditions more likely the conditions that you need to more likely have the experience that you’re looking for.

But in non-duality, everything exists simultaneously; what you’re looking for is already here. I would rather start with that, saying the peace and love you want is already in you. Even if you’ve never touched it for years, a non-dual practice can have you touch it very quickly, very cleanly. Psychedelics, especially ketamine, can give you that experience very quickly. That’s what I want them to experience as soon as possible, because then they can infuse that into their waking lives through their trauma, through the depression, through the anxiety, that will, of course, still linger after your treatment.

But you’re doing it from a place that you’re not at lack, it’s already there. Where a dual approach is, you have to keep doing these things over and over, and hopefully you’ll get there and touch it one day. If you’re lucky, it’s closer than far, but the non-dual living is that it’s already here. It’s right now. And it includes everything. It doesn’t mean you’re not going to feel pain. Pain’s included in the non-dual experience, but so is ease and joy. That’s what I mean.

[00:30:17] Scott Snibbe: It’s realizing that solution isn’t outside of yourself? That solution’s a continuum that’s within you and in relation to everything around you?

[00:30:27] Dr. Michael Sapiro: Yes, it’s accessible, it’s practical. Why not we start there?

Inequality and social injustice regarding psychedelics

[00:30:34] Scott Snibbe: I’m really curious about any variations in the acceptance or effectiveness of these treatments across socioeconomic differences, race, gender, religious beliefs, and so on. These therapies are, they’re trendy right now, especially here in California, among certain circles of friends I know, in the arts and technology, are really into them.

Can you talk about how these treatments work across people from different backgrounds?

[00:31:01] Dr. Michael Sapiro: We’re going to get a little bit into social justice, into health equity. African Americans were tested on without consent. There’s a whole history of abuse in the medical system outside of psychedelics and with psychedelics. The culture of mushrooms were stolen from Latin American, South American, Mexican American places without consent.

We have to think about not only who has access, but how would you feel if you were Black American and you’re like, Hey, do you want to try this thing that your ancestors or your lineage or your family or people were coerced into using them? I’d be like, No, I don’t trust the system. We have to acknowledge all the pain and the oppression and the marginalization that has come.

Is it a white person drug again? Marijuana was illegal and black people are in jail for nothing. And now everybody sells it, it’s all cool. That’s bullshit and it’s harmful. It needs to be addressed openly and honestly so that people first do the repairing work that they need, interculturally between us all. Then we can make it equally accessible without fear attached to it.

If a black person has mushrooms and a white person has mushrooms, and one gets pulled over and the other gets let go what’s the relationship to mushrooms then? To ketamine? To psychedelics? It’s unequal. So it’s not just what does it do for someone who’s Latino? What does it do to their psyche thinking about it? We have to think about that. What’s the relationship of a substance to a person based on oppressive qualities of our cultures?

That’s what I think about. The field is talking a little bit more about it, not enough. Then we don’t have research on what are the differences between cultures and medicine use and therapies. We don’t have enough information to make it clear. There is a push from the field to bring in people of color, transgender, gay, lesbian, queer, to make sure everyone has a voice. But right now it’s becoming capitalized and corporatized.

That means, generally speaking, wealthier white people who have resources get to build the companies. They’re going to have a block for, access to people who are poorer, who need it just as bad. These are much larger conversations we could definitely have, but I do want all of us to consider that it’s not equal access. It’s not equal freedom and ability to use. It’s scary for people to use drugs when they’ve been locked up for it.

[00:33:52] Scott Snibbe: Then on the other side too, there’s some indigenous cultures that it’s very important that the treatment remains within their community and doesn’t get spread outwards. That was also one of the things in Michael Pollan’s show that he talked about. Then other traditions want to share it and want to open it up to everybody, so it’s very complicated.

[00:34:13] Dr. Michael Sapiro: It’s extraordinarily complicated. We want to be discerning and listen and practice restorative justice, so we know how to take feedback, take criticism and go, I hear you, here’s what I hear you’re saying, what do you need, what do you want, and we collaborate together as we move forward as a field.

I do not pretend to be a shaman, I’m not trained in the shaman lineage. Some of my practices do open up ancestral spiritual realms, because that is what medicine does. I have trained in that but I do not call myself a shaman because I’m not trained in a shaman lineage, I don’t have a teacher in any of those.

Indigenous means coming naturally from a place. We all have indigeneity within us, whether it’s Africa, Palestine, Siberia, or South America. All of us listening have history with the lineage behind us that becomes indigenous. We all can go back to those roots. That’s why it becomes even more complex than just saying indigenous. That doesn’t mean Native American. It means wherever we’ve come from. We want to be careful to include all that so we can honor each of us who come and all of our heritage.

[00:35:30] Scott Snibbe: As a practitioner of Tibetan Buddhism, we’re really aware of that because the lineage is very important and you memorize and you study it. Tibetan Buddhism wasn’t indigenous to Tibet. It came from India and it wasn’t colonized, it was invited. But you’re very grateful to that lineage from India.

Then the Tibetans are very generous with sharing it with Westerners and all the other cultures where Buddhism has spread. Tibetan Buddhism is a nice example where lineages move between cultures with generosity and respect rather than the exploitation, colonization.

[00:36:06] Dr. Michael Sapiro: I feel that with Zen, too. As I lived in a Zen temple for a year, every morning we chanted our lineage, which starts with Indian through Chinese, then Korean and Japanese through the American, to Oregon, where I was. It’s a beautiful gift of remembering where it came from and honoring that lineage.

Who should and shouldn’t consider psychedelic therapy?

[00:36:25] Scott Snibbe: For these type of therapies I’m sure people listening are thinking, Could this help me? When would it be appropriate for someone to be considering psychedelic therapy and when wouldn’t it be?

[00:36:47] Dr. Michael Sapiro: I’ll start off when wouldn’t it be because more people than not can probably do this therapy. And all of you listeners, I’m not giving you permission to do this. I take on no liability or responsibility for you going out and saying, Dr. Mike said it’s fine, I don’t have these things, it’s going to be good. No, you have to discern, you have to do medical and psych screenings, know what’s good for you.

I will say people who are actively suicidal, meaning I am ready to do it and I have a plan. That’s not the time to do it. Although in some psychiatric hospitals, they are using ketamine to help diffuse some of that acute suicidality, but that’s in a controlled environment. My clinic will not accept people in that acute state. We send them to a hospital if needed, and then they can come back. It’s up to the hospital to administer ketamine or not. But I don’t know if they have psychotherapy.

There’s the medical model where you’re just getting an infusion or injection and you and the medicine work. Then there’s the model I work under, which is the psychotherapeutic model. I’m doing therapy with you.

If you have psychosis, or you’re active in a manic episode, it’s contraindicated. You don’t want to be doing psychedelics if you have schizophrenia, or schizoaffective disorder, a thought disorder. If you have neurological disorders, if you had stroke in the last year, you wouldn’t want to do ketamine. There’s medical concerns, if you’ve had heart or cardiac issues MDMA might not be the medicine for you because it could be cardiotoxic, it increases your heart rate, it’s like amphetamine. You don’t want to take amphetamine if you have a heart condition.

So people with medical conditions that are contraindicated for different psychedelics are going to want to ask their providers, ask the guide. Be careful, please be careful with your body and your mind because these medicines are potent. If you’re prone to psychosis or heavy delusion, you don’t want to add a medicine that makes the reality seem more unstable than you see it already. Think about it.

Someone with active psychosis is seeing the world in fragmented ways, that’s what a psychedelic does, it makes everything fragmented. You definitely don’t want to be doing a drug that increases destabilization. That being said, that’s not an exhaustive list. That’s an example of some things I would be mindful of and as are my clinic staff.

That being said, who is it good for? When people are ready to make serious changes and they’ve done therapy but it hasn’t worked for them. When they’ve done other forms of therapy and it hasn’t worked for them. When they’re ready to speak their truth and need help getting there. When people are ready to thrive but don’t know what’s holding them back. When people are not letting go of their grievances and they find themselves stuck in self pity.

A lot of people don’t like to admit they’re stuck in self pity. I call it indulging self pity. When people are ready to face their deepest wounds but need support doing it because they just keep getting in their own way. When people are using drugs and alcohol to numb themselves rather than to really feel what they need to feel. These are all good indications psychedelic psychotherapy might be useful.

I want to make a discernment between psychedelic therapy where the client and the medicine work primarily together with a guide sitting there—that’s what Michael Pollan was mostly talking about—versus what I’m doing, which is psychotherapy. I’m actually talking while the person is on, we’re talking together. So the dose becomes important because when you’re doing psychedelic therapy, you can do a high dose and the guide will help you and guide you. But if you’re doing this really high dose with me, I can’t do psychotherapy.

The dose becomes much more important where we’re in a good range where they’re in and out of the psychedelic state but I’m doing psychotherapy during it. So people who are ready to really face themselves and love themselves and get through it, psychedelic psychotherapy could be very helpful.

Is psychedelic psychotherapy legal?

[00:40:56] Scott Snibbe: This is a very basic question but is this legal? Is someone putting themselves at risk of getting arrested or something?

[00:41:02] Dr. Michael Sapiro: Ketamine is used off-label. It has not been approved for psychotherapy, but it is being used legally for psychotherapy. MDMA is legal in studies; the FDA and DEA have approved the use of MDMA and psilocybin for research studies. Other than that, no.

I think some states have decriminalized or even legalized the use of psilocybin mushroom but they’re not at a place where you’re allowed to do therapy with them. There’s just lots of complication, people are mostly doing this underground. I have to go to Mexico to do my work with other substances with people and groups. People fly me out to lead groups or individuals who have resources to fly me out to do this type of therapy, they do. I also work in veteran groups that we do it legally in other countries, we get grants and donors give money for my combat vets and me to fly down and do the work.

Everybody takes a risk working underground, whether it’s a therapist, a guide, a shaman, or the clients themselves, it’s all a risk. One of the good things about getting regulated is that we can have practices that are more regulated. We can regulate therapists, get them trained, make sure they’re doing the best practices. Regulating anything takes sometimes the magic out of it but it can get people to be safer.

Working with combat veterans and men’s mental health

[00:42:32] Scott Snibbe: Can you talk about your work with veterans and how these therapies have benefited them?

[00:42:38] Dr. Michael Sapiro: I’ve spent a lot of time with combat vets as a psychologist trained at the VA and worked many years with combat vets. It’s very much like my first responders, you’re coming up against a lot of issues of control. My veterans who have been in combat, especially the special operations veterans are highly trained to have control over their body, their mind, where their attention goes, trying to be a regular human being after going into combat and being a father or being a spouse.

Same for my first responders who are in and out of fires or tackling perpetrators, you go home and you’re on edge all the time because you’re always looking for danger. Then you introduce a medicine that strips you of your ego’s control. It’s a beautiful theater to witness. A lot of screaming, a lot of yelling, a lot of hell no’s, a lot of I don’t wanna die. Because it feels like you die sometimes in these experiences, and I’m like, Die, die, dude. Let that part of you die that’s over-controlling.

Let that part of you die that’s over-controlling.

I have kids. I’m like, You’re not really gonna die, bro, just let go. But my work is to actually help them do it in real time, doing the letting go. Lots of trust, I hold their shoulder, their hand. I’ll hold their head and let them cry and scream. After a while, when they do learn to let go and to trust, I prep them to float on a river before we get to the hard part. I remind them, let yourself float.

That’s the best part of treatment, they start to let go of that control which they needed to survive. Which they don’t need as much now. Then they get to the heart. I love helping men become spiritual warriors. They’ve done the real warrior work, now we get to be spiritual warriors and be vulnerable, come into the heart, talk about feelings. It’s a beautiful transformation. The best part of my work is watching a very strong, capable man become capable and strong in the heart.

The best part of my work is watching a very strong, capable man become capable and strong in the heart.

[00:44:47] Scott Snibbe: What resources would you recommend for men who want to become spiritual warriors and open up like that? Many of our problems in our culture do come from men who are locked out of an awfully large part of their psyche.

[00:45:01] Dr. Michael Sapiro: There’s a lot of good groups that are doing men’s work and a lot of psychedelic groups, I’m sure people can find, I’m a resource. I can’t work with every individual or group that comes to me, but I can refer. That is the work that I do in the world because a lot of damages come from controlling, possessive men, and I’m sure there’s women going uh-huh, yes, tell us more. How do you work with them?

My job is to help them drop in the heart, break the boundaries that can find them, and I do this organizationally, with groups, and with individuals. There has to be a willingness and the beauty of it is most first responders and combat vets coming in and going, I’m being an asshole to my kids and I don’t want to do that anymore I’m like, Awesome, that’s a great motivation until we get to the inside where we self motivate. I want to be better for myself. Hey, if you’re starting off because you want to be better to your spouse and your kids, great place to start.

The awakened heart

[00:46:02] Scott Snibbe: Is there anything else you’d want to add about this connections between psychedelic psychotherapy and meditation in Buddhism?

[00:46:09] Dr. Michael Sapiro: It’s all heart. Jack Kornfield’s teacher—I’m in the same lineage in Thai Buddhism—Ajahn Chah, who is in Northeastern Thailand, on the back of one of his books, excerpt of teachings, dharma talks, called A Still Forest Pool, says, you get to a place in your practice where the heart tells itself what to do.

The bodhicitta, the awakened heart is where we’re going in all three of those. Psychedelic psychotherapy leads our consciousness to our heart. We’re residing in the heart. We’re talking from the heart. We’re acting from the heart. We eat from the heart. Make love from the heart. Scold from the heart, admonish from the heart, acknowledge our faults from the heart.

That’s what all of this does. It ends up with us being kinder to ourselves and to other people and to the world and the planet. It’s all the same. This is just a very rapid way of dropping into the heart and then living from there.

Michael Sapiro’s guided meditation

[00:47:16] Scott Snibbe: That’s very beautiful. In next week’s episode, we’re going to air a meditation that you guide.

Is there anything you’d like to say about that meditation or we’ll just let it be a surprise?

[00:47:29] Dr. Michael Sapiro: What usually happens in my meditations is we start off with dropping into the body because it’s very hard to automatically drop into a non-dual state. The mind isn’t ready for that. Our bodies are not even online. We need our bodies to feel the essence of life. What people miss, and what I often do in even psychedelic psychotherapy is dropping into the body, feeling this thing that connects us to what we are and to the universe.

We drop into the body, then we ground energy through the feet. We’re destimulated, regulated, and then we come into the heart. From the heart we expand into the greater sense of the universe. It’s a process, but it’s a process leading to you what’s already here. That’s all I’ll say. I don’t know what’s coming, who knows.

[00:48:19] Scott Snibbe: Wonderful. Mike, thank you so much for talking to me about this relatively new field, at least in our culture, of psychedelics, psychotherapy, and how it connects to Buddhism and meditation. I really enjoyed talking to you.

[00:48:32] Dr. Michael Sapiro: Thank you so much for having me on, and I hope this opens the hearts of all the listeners, and it makes a difference for people listening.

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Credits

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