Psychedelic Therapy in Mental Health: Learning From the Past

by Shirli H Libet, MS LMFT

In the last few years, the conversation around psychedelic assisted therapy has grown very quickly. In professional meetings, clinical trainings, and online discussions, we hear more and more about ketamine assisted therapy, MDMA assisted therapy, and psilocybin therapy for depression and PTSD.

As a therapist who works with trauma and complex mental health conditions, I understand why people are excited. Some of the research is very promising, especially for individuals who have not responded to traditional treatments.

At the same time, I also find myself feeling cautious.

History already showed us what can happen when a treatment becomes misunderstood or misused. Psychedelic medicine experienced this once before. If the field grows too fast without enough structure and responsibility, there is a real risk that progress could slow down again or even stop.

This is not an argument against these treatments. In fact, it is the opposite. I believe strongly in the potential of psychedelic therapies. That is exactly why I feel the need to raise this concern.

As I see ketamine assisted therapy becoming more and more available everywhere, it makes me pause. It reminds me a little of what happened in the past, when promising treatments moved too quickly into the public space without enough structure.

Because I believe in ketamine therapy, MDMA assisted therapy, and psilocybin research, I also believe we need to protect the field by moving carefully and responsibly.

When Psychedelic Research Was Stopped

Many people do not realize that psychedelics were originally studied in medicine and psychiatry.

In the 1950s and early 1960s, LSD and psilocybin were actively researched for mental health treatment. More than 1,000 scientific papers were published and around 40,000 patients participated in studies before these substances became illegal (Rucker, Iliff, Nutt, 2018).

Researchers explored psychedelic therapy for conditions such as:

• depression

• alcoholism

• trauma

• end of life anxiety

Some early results were very encouraging.

However, things changed quickly in the late 1960s. Psychedelics became strongly connected to the counterculture movement. Recreational use increased, and some public figures encouraged people to experiment with psychedelics outside medical settings.

The public conversation shifted away from science and toward fear.

In 1970, the United States passed the Controlled Substances Act, placing LSD and psilocybin in Schedule I, meaning they were classified as drugs with high abuse potential and no accepted medical use.

Almost overnight, psychedelic research stopped.

For decades, scientific work in this area disappeared.

The Return of Psychedelic Research

In the early 2000s, research into psychedelic therapy for mental health slowly began again.

Universities such as Johns Hopkins, Imperial College London, NYU, and UCLA started conducting carefully controlled studies.

Today three treatments are receiving the most attention:

• Ketamine Assisted Therapy (KAT)

• MDMA Assisted Therapy for PTSD

• Psilocybin Therapy for Depression

Ketamine is currently the most widely available option. Studies show that ketamine can produce rapid antidepressant effects for treatment resistant depression, with about 50 to 70 percent of patients experiencing meaningful improvement (Sanacora et al., 2017; Krystal et al., 2019).

Research on MDMA assisted therapy for PTSD has also shown strong results. In a large clinical trial, about 67 percent of participants no longer met criteria for PTSD after treatment (Mitchell et al., 2021, Nature Medicine).

Psilocybin studies are also showing promising outcomes. One clinical trial found that more than 70 percent of patients with major depression experienced significant symptom improvement (Davis et al., 2020, JAMA Psychiatry).

For clinicians working with trauma, depression, and addiction, these findings are very meaningful.

Why the Approval Process Feels Fragile

Even with promising research, approval of psychedelic therapies is not guaranteed.

Regulators are carefully reviewing safety, therapist training, and research design. In recent reviews of MDMA therapy studies, some experts raised questions about how therapy sessions were conducted and whether therapist involvement may have influenced outcomes.

There are also discussions about how these treatments will be delivered safely in real world clinical settings and how patients will be monitored over time.

These questions do not necessarily mean the treatments do not work. Instead, they show that the approval process for psychedelic assisted therapy is complex and cautious.

This moment reminds us how fragile progress in this field can be.

The Rapid Growth of Ketamine Therapy

Among psychedelic treatments, ketamine assisted therapy is expanding the fastest.

Many clinics now offer ketamine treatment for:

• depression

• PTSD

• suicidal thoughts

• trauma related conditions

There is no doubt that ketamine can help many people.

At the same time, professionals in the field are beginning to ask important questions about responsible ketamine treatment protocols and the possibility of overuse.

When treatments expand quickly, there is always a risk that the focus moves too much toward the drug experience itself instead of the therapeutic process around it.

If psychedelic therapy is going to grow in a healthy way, these conversations are important.

What Responsible Psychedelic Medicine Looks Like

As I continue my training in psychedelic assisted therapy  while also working as a certified EMDR therapist, I hear a consistent message from researchers and clinicians leading this field.

Responsible psychedelic medicine requires structure and careful training.

In the programs I am studying in, several themes are repeated again and again.

First, careful screening of patients is essential. Not every individual is a good candidate for psychedelic therapy.

Second, preparation and integration therapy are critical parts of treatment. The medicine itself is only one part of the process. The psychological work before and after the experience is just as important.

Third, therapists must receive specialized training in trauma informed care, because psychedelic sessions can bring up intense emotions and memories.

These principles are not ideas I developed myself. They are the standards consistently discussed in professional training programs for psychedelic assisted therapy.

Why I Still Believe in This Work

After more than 20 years working as a licensed therapist, first in New York and later in California, I have seen both the strengths and the limits of traditional treatments.

Talk therapy can help many people. It can build awareness, strengthen relationships, and support emotional healing.

But when we look at severe anxiety disorders, depression, PTSD, and substance use, we also see how much suffering continues despite treatment.

Medications such as SSRIs help some patients, but for many people the process is long and difficult. Sometimes improvement is partial, and the burden on the individual, family, and community remains very heavy.

Because of this, the mental health field continues to explore other approaches that may help people who have not found relief through existing treatments.

A Documentary Worth Watching

For clinicians interested in understanding the human side of trauma treatment, I recommend watching the documentary In Waves and War, available on Netflix.

The film follows veterans living with severe PTSD and explores new approaches to healing.

It offers a powerful reminder that behind every research study are real people searching for relief from suffering.

Final Thoughts

The research on ketamine therapy, MDMA therapy, and psilocybin therapy is promising.

The need for better treatments is real.

But if this field is going to continue moving forward, it must grow carefully and responsibly.

The future of psychedelic medicine will depend not only on the science, but also on how wisely we choose to use these tools.

To learn more about my work in trauma therapy and emerging treatments, visit:www.HealthyFamily4Life.com

You can also follow my updates and professional insights on Instagram:@ShirliMindBodyGuide