Co-Creating the Therapeutic Experience

Co-Creating the Therapeutic Experience: Nurturing Relational Dynamics and Growth

Therapy is often thought of as a journey, one embarked upon with a guide—the therapist—who assists individuals in navigating their inner landscapes. However, the traditional model of therapy, characterized by a power dynamic where the therapist holds expertise and authority, is evolving. In contemporary practice, there’s a growing recognition of the importance of co-creation within the therapeutic relationship. This shift becomes even more pronounced with the integration of psychedelic-assisted therapy, where the relational experience is magnified within a therapeutic container.

A Balance of Prediction and Present Moment Experience: Intentional Learning

Central to the concept of co-creation is the acknowledgment of power dynamics inherent in the therapeutic relationship. Traditionally, therapists hold a position of authority, which can inadvertently hinder true collaboration and co-creation. When clients passively accept the therapist’s interpretations or when therapists drive the therapeutic process without active client participation, the essence of co-creation is compromised. To foster genuine collaboration, therapists must strive to create a “power-with” dynamic, where expertise is respected, yet authority is shared. Traditional therapy often involves a “power-over” dynamic, where the therapist holds authority over the client. In contrast, a feminist orientation towards therapy proposed by Carolyn Zerbe Enns and Sandra Peacock emphasizes collaboration and empowerment, aiming to create a “power-with” dynamic where the therapist and client work together as equals (Enns & Peacock, 1984).

Recognizing and deconstructing power dynamics within the therapeutic container necessitates continuous self-reflection, acknowledgment of biases, and a commitment to ongoing self-work, including shadow work—a process of exploring and integrating one’s hidden aspects. By engaging in this inner work, therapists can mitigate the influence of power differentials and create a more egalitarian therapeutic space conducive to co-creation. A strong therapeutic container enables a client’s inner healing intelligence to guide their healing journey rather than the often unrecognized implicit biases of the facilitator (Vaid & Walker, 2022)

Examples of Co-Creating the Therapy Experience

Co-creating the therapeutic experience encompasses various facets, each aimed at fostering mutual understanding, empowerment, and agency. A pivotal aspect of co-creation involves explicitly addressing social location, identities, and power differentials based on both the therapist’s and client’s backgrounds. This orientation towards therapeutic work can increase the efficacy of psychedelic-assisted therapy through five channels described below.

Increased Awareness and Understanding:

Acknowledging social location, identities, and power dynamics allows both therapist and client to gain a deeper understanding of how these factors shape their experiences, beliefs, and behaviors. This awareness can foster empathy, reduce biases, and promote a more authentic therapeutic relationship.

Cultural Humility:

By addressing social location and identities, therapists can develop cultural humility, which is crucial for providing effective therapy to clients from diverse backgrounds. Understanding the cultural nuances and contextual factors that influence clients’ lives can lead to more culturally responsive interventions and better outcomes. Cultural competency refers to a therapist’s ability to understand, appreciate, and effectively interact with people from different cultures. Cultural humility builds upon this idea shifting focus towards self-awareness, introspection, and relational engagement rather than acquiring knowledge about other cultures. Cultural humility is an approach to therapeutic work that involves recognizing one’s own limitations in understanding and engaging with diverse cultures. It emphasizes the importance of humility, openness, and ongoing self-reflection in cultural interactions. Cultural humility acknowledges that no one can fully understand or be competent in every aspect of every culture, and it encourages individuals to approach cultural learning with an attitude of openness, curiosity, and respect.

Empowerment and Validation:

Addressing power differentials validates clients’ experiences and perspectives, empowering them to voice their concerns and assert their needs within the therapeutic process. It can help marginalized clients feel seen, heard, and respected, thereby enhancing their sense of agency and self-worth.

Intersectionality:

Recognizing the intersecting identities and social locations of both therapist and client (e.g., race, gender, sexual orientation, socioeconomic status) enables a more nuanced understanding of how multiple forms of privilege and oppression intersect to shape individuals’ lived experiences. This intersectional perspective helps psychedelic-assisted therapists tailor the therapeutic environment in a way that accounts for the complexity of clients’ identities and social contexts. This might look like culturally specific objects, music, or practices in the therapy room– or specific guidelines around how certain topics should be discussed during the medicine session.

Equity and Social Justice:

Addressing social location and power differentials aligns therapy with principles of equity and social justice. Therapists can actively work to dismantle oppressive structures and advocate for systemic change both within and outside the therapeutic setting. This not only promotes the well-being of individual clients but also contributes to broader efforts to create a more just and inclusive society. Within this context of psychedelic-assisted therapy, this could be exemplified by a therapist’s efforts to call for reciprocity initiatives in their practice, or create a sliding-scale payment model for their clients.

Additionally, collaborating on defining therapy goals and intentions empowers clients to take an active role in shaping their healing journey. This collaborative approach ensures that therapy aligns with the client’s needs and aspirations, enhancing efficacy. Alongside alignment around goals and intentions is a shared recognition of the importance the therapeutic setting holds. When a therapist is able to co-create both the mindset and the environmental setting with their client, psychedelic-assisted therapy can provide the highest degree of long-term transformational growth (Doblin, 2011). Co-creating the setting can include collaborative input on elements like décor, seating arrangements, and sensory stimuli– ultimately contributing to a sense of ownership and comfort for both parties. A psychedelic-assisted therapist must consistently foster a conducive environment for exploration and growth, both psychologically and physically. One final example of co-created experience comes in the form of mindfulness practices. Incorporating introspective work within sessions serves as a tool for checking assumptions, clarifying understanding, and guiding clients towards a curious exploration of their inner experiences, further enriching the co-creative process.

Interrupting Habitual Meaning Making

A significant aspect of co-creating the therapeutic experience involves disrupting habitual patterns of meaning-making—automatic interpretations, beliefs, emotions, and behaviors ingrained through lived experiences. Psychedelics, with their capacity to “unlock” entrenched neural networks, offer a unique opportunity for updating these patterns (Roseman, Kaelen, & Carhart-Harris, 2020). However, without conscious awareness of these habitual tendencies, transformative opportunities may be overlooked. Psychedelic-assisted therapists play a crucial role in facilitating this process by encouraging clients to slow down and cultivate curiosity towards their experiences. This may involve practices such as active listening, devoid of premature interpretations, or asking probing questions to deepen self-awareness. In somatic approaches, therapists guide clients towards bottom-up exploration, facilitating the co-creation of new meanings from bodily sensations and felt experiences. By assisting clients in unraveling their habitual meaning-making processes, and prompting them to develop personalized strategies for resourcing, therapists enable them to transcend limiting narratives and cultivate greater insight and resilience.

Co-creating the therapeutic experience represents a paradigm shift towards a more collaborative approach to healing that empowers a client’s inner healing intelligence. By acknowledging and addressing power dynamics, fostering collaborative dialogue, and facilitating mindful exploration of habitual patterns, therapists encourage clients to become active agents in their own growth and transformation. As the therapeutic landscape continues to evolve, embracing co-creation not only enhances therapeutic outcomes but also cultivates deeper trust, authenticity, and mutual respect within the therapeutic relationship.

The worksheet Beckley Academy developed for clients to track shifts in their experience after psychedelic-assisted therapy sessions in the days and weeks that follow, presents an opportunity for collaborative meaning making that supports transformation. This resource encourages clients to practice mindfulness regarding any perspective shifts– without necessarily making meaning of the experience– and in integration sessions facilitators can use this information to help the client identify unhelpful patterns through the meaning-making process.

Download the worksheet here

References

Doblin, R. (2011). The importance of context in psychedelic therapy. Journal of Psychoactive Drugs, 43(3), 206-212. https://doi.org/10.1080/02791072.2011.606695

Enns, C. Z., & Peacock, S. (1984). The Power-With: A Fundamental Principle of Feminist Therapy. Women & Therapy, 3(4), 47-56. https://doi.org/10.1300/J015V03N04_05

Roseman, L., Kaelen, M., & Carhart-Harris, R. L. (2020). Psychedelics promote structural and functional neural plasticity. Cell Reports, 32(3), 107908. https://doi.org/10.1016/j.celrep.2020.107908

Vaid G, Walker B. Psychedelic Psychotherapy: Building Wholeness Through Connection. Glob Adv Health Med. 2022 Feb 23;11:2164957X221081113. doi: 10.1177/2164957X221081113. PMID: 35223197; PMCID: PMC8874171.