Welcome and Introduction of Dr. Will VanDerveer
Lia Mix: Welcome to Delphi’s July Insight Session. Today, our guest has spent more than two decades doing the patient, unglamorous work of rebuilding psychiatry from the ground up.
Dr. Will VanDerveer is a psychiatrist trained at Vanderbilt University and the University of Colorado. He is the co-founder, alongside Keith Kurlander, of the Integrative Psychiatry Institute and Integrative Psychiatry Centers in Boulder, Colorado.
Over the past 20-plus years, Will has trained thousands of clinicians around the world in integrative psychiatry and psychedelic-assisted therapy [a model that combines psychedelic medicine sessions with preparation, therapeutic support, and integration]. He has also served as a co-investigator on Multidisciplinary Association for Psychedelic Studies (MAPS) co-sponsored clinical trials studying 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder (PTSD).
Will recently released a new book with Keith Kurlander titled Psychedelic Therapy, which became a New York Times bestseller.
He joins us at a moment when the field he helped build in relative obscurity is facing a new set of pressures: scale, speed, regulation, and the question of who gets to do this work as it moves into the mainstream. Please join me in welcoming Dr. Will VanDerveer.
Will VanDerveer: Thank you, Lia. It’s a pleasure to be here.
Lia: We are both in Boulder, Colorado, so it is a delight to have a fellow Boulderite on the Insight Session today. Although you are in Boulder, your impact has been much broader than that. You have spent decades building and looking at this field not just in the United States, but internationally as well.
Will: It is an honor to be your friend and colleague, Lia.
We have been working on different sides of the same problem for a very long time. It is valuable to have like-minded colleagues doing this work. The word “unglamorous” applies as much to your deep work as mine: organizing stakeholders, getting people aligned, and doing the behind-the-scenes work that often remains invisible.
From Conventional Psychiatry to an Integrative Path
Lia: I want to start with some background to lay the foundation for where you are now and where you think things are going.
You have described unresolved emotional trauma as the most significant root cause of psychiatric symptoms. That view was probably well outside what you were taught at Vanderbilt. What moved you from conventional psychiatric training toward this integrative path?
Will: I was trying to become a psychiatrist like the other people in my class. I came out of residency excited about practicing psychiatry. I had the tools I was board-certified to provide: cognitive therapy, medication management, and related approaches.
Very quickly, it became apparent how many people did not respond to conventional treatments. It was devastating. I saw a future in which my work as a psychiatrist would become a carousel of medication changes and diminishing results.
A large study came out right after I graduated from residency, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial [a major antidepressant effectiveness study], and it confirmed my concerns. Essentially, each time you change an antidepressant, the chance of benefit gets lower. That is discouraging for many people.
So I set out to understand what was wrong with what I had learned. I started with integrative medicine, learning about the gut-brain connection, hormones, inflammation, and infections. I started running stool tests with psychiatric patients and building a fuller toolkit. That helped more people than the conventional toolkit, but it still left many people struggling.
Then I trained in somatic psychotherapy [body-based psychotherapy] for trauma. I was doing somatic therapy, but it was not until I became involved in MDMA clinical research with MAPS that I saw how quickly psychedelic therapy could change the course of someone’s life after decades of struggle. That was when I felt we were starting to get somewhere as a field.
That is a summary of a 20-year trajectory.
Lia: Thank heavens you were attuned to what was happening. I was a clinician in what I consider the bad old days, in the early 2000s. We saw people making tiny, slow progress, if any, with a lot of relapse and suffering. The moral injury was very real for those of us working in the field.
People like you have been instrumental in bringing new hope: change can be lasting, and people do not have to live out their diagnosis for the rest of their lives. I think I would enjoy being a clinician much more now than I did back then.
Will: It is no fun living inside the belief system that tells clients: you are going to be in this system forever, you are going to take these medications forever, and you are going to depend on mental health care forever. That is not what providers sign up for.
Now we have more effective tools that allow us to put our money where our mouth is and say: we are going to intervene in a short-term way, help you get back on your feet, and help you put mental health care behind you.
Early Psychedelic Training and Building in an Emerging Field
Lia: A major part of that new day is psychedelics. Long before psychedelic therapy had institutional legitimacy, you and your team were doing things like sending people to Amsterdam with a camera crew to document psilocybin sessions. That was years before Oregon or Colorado legalized anything.
In those early, almost improvisational years of training thousands of practitioners across 60 countries, what did you learn that you could not have learned any other way?
Will: We learned a lot in those days. Maybe the most useful answer is that people everywhere want the same thing: the joy and freedom of having mental health challenges behind them.
Providers around the world want better approaches. They want more effective, interventional models that do not condemn people to lifelong dependency. We certainly had challenging moments along the way, not least of which was navigating state psilocybin rules across different states.
I also did not appreciate what it was like to work inside an emerging market that had not yet emerged. There was so much infrastructure we had not thought about. How do you find liability insurance to work with people using psychedelics? It was a brand-new thing.
Lia: That infrastructure matters: safety, standards of care, and knowing who is right for treatment and who is not. Those were real adventures.
Before we talk more about the present moment, I want to ask about your personal story. How did you get into psychiatry and psychedelic therapy?
Will: I did not plan on going to medical school. Late in my senior year of college, I joined a research project studying schizophrenia. The patients I had the privilege to interview in psychotic states felt like my people. I wanted to be around them.
I realized I needed to go to medical school to do that. I entered with the idea that I wanted to be a psychiatrist, though my advisors strongly counseled me not to bring that up in medical school interviews. They wanted the school to think I was soft clay they could mold.
I became very excited about the biology of the body, mind, and brain and almost went in a different direction in medical school. But I was driven by conscious and unconscious wishes. Consciously, I wanted to understand what was going on with the mind: what mental illness actually is, and how we can support people through it.
Unconsciously, I think I also knew there were unanswered questions and trauma from my own childhood. It was not until I had been in practice for about 10 years that it started to dawn on me how much trauma I needed to face in my own life.
Lia: I resonate with that. When you said, “When I was with the patients, I felt like these were my people,” I recognized that. We were not encouraged to look at ourselves that way in behavioral health training. Maybe you were supposed to do a year of therapy and take a small peek under the hood, but not really look.
For many people in the field, it takes a decade or more to identify unresolved trauma in themselves. That is a huge change in behavioral health care: we now have tools to look at trauma and treat trauma. Trauma-informed care [care that recognizes and responds to the effects of trauma] is now a major focus, thanks in part to people like you.
Writing Psychedelic Therapy for a Broader Audience
Lia: Congratulations on Psychedelic Therapy becoming a bestseller. What were you and Keith trying to accomplish with this book that was not already out there?
Will: Keith and I have been training clinicians for many years. We started talking about writing a book when we noticed that, in public conversations with people outside the field, people would ask what we did. We would say, “We are training thousands of people in psychedelic therapy,” and they would respond, “What is psychedelic therapy?”
We realized there was a large unmet need among people who are not mental health professionals. They needed to understand the process from a sober, responsible point of view, including:
- The drawbacks
- Who should not undergo psychedelic therapy
- Who it might help
- What the process involves
- Where people can access services
- Whether insurance covers it
- How different medicines compare
We wanted to meet a general audience with questions. For example, if someone has depression and has tried and failed a selective serotonin reuptake inhibitor (SSRI) [a common class of antidepressants], another class of antidepressant, or therapy, those are often the people best served by psychedelic therapy: people who have tried other approaches and not been helped.
Lia: That is a perfect segue. You mentioned during our pre-interview discussion that most true believers in this field have already been trained. Now the next wave coming through is less familiar with the work. At the same time, pharmaceutical companies are pushing for faster, larger-scale training.
How are you and Keith navigating the tension between training depth and training speed?
Will: The tension between quality, depth, and meeting a huge need is real. There is no easy or quick answer.
One thing we keep emphasizing is that professionals in this field need to continue meeting with each other, getting supervision, and developing expertise over time. That expertise takes years to develop.
Beginners can come along by being exposed to people with more experience. Didactic education [lecture-based or instructional education] and online education have a role; they build a foundation. But in my experience, relationships with people further along in wisdom, expertise, and depth make a major difference in how quickly people become ready for the work.
So it requires a combination of approaches, including the best technologies available.
Lia: We are still building the plane while flying it. That requires people who are paying close attention to the nuances between speed and access on one side, and depth, safety, and effectiveness on the other.
Will: “Building the plane while flying it” is a useful way to describe what is in front of us. My mother-in-law was texting me last week from a tarmac, where the plane had a mechanical issue. They had to change the plane, and I was very happy they did.
Lia: Exactly. We need to know when to change the plane and when not to.
Safety, Preparation, and the Limits of the Chemical Cure
Lia: That leads into safety. The train has left the station. We do not yet have Food and Drug Administration (FDA) approval, but people feel it is coming. State-level therapeutic use programs are emerging. Religious use is increasing. Recreational use is increasing.
As wider use grows, we are going to see more adverse events. Where do you see the biggest gaps in the system’s ability to recognize, respond to, or prevent those events? What needs to happen for expanded access to be safer?
Will: This connects to why we wrote the book. A tremendous amount of risk reduction happens in preparation.
Many people who suffer adverse events have not been adequately prepared for what is in front of them. Screening matters too, but the belief system a person brings into the experience is critical to outcomes.
As a psychiatrist with 25 years in the field, I think it is fair for me to critique psychiatry from the inside. We have created a kind of monster: the idea that the thing you put in your mouth, the pill you take, is the answer, the treatment, the entirety of what one needs to do to feel well. “I have a serotonin deficiency, therefore I will take Prozac, and that will cure my problem.”
Those are empty promises, and our culture reinforces that view. Through hard work on the back end, in integration [the process of making meaning from the experience and applying it to daily life], we can help people put mental health care behind them. But that will not happen if we subscribe to the view of the chemical cure.
When I see people in my practice, or people we have worked with, not getting well or having difficult experiences, I often think we have not done enough on the front end to help them understand the work required to get well. That represents a large percentage of risk reduction.
We also need guardrails around safeguarding, ethics, and protection of the sensitivity of a person on a psychedelic. I am worried that preparation and integration will get short shrift, because most of the healing happens in integration and follow-up sessions, not during the medicine session itself.
Lia: I agree. Most prevention of adverse events happens in preparation and proper screening.
What I appreciate about your answer is that you went to the heart of a core issue in psychiatric and behavioral health treatment: the ingraining of illness in the patient’s identity. That can become an obstacle to full remission. With many other illnesses, people can be in full remission; they no longer have it. It is in the past.
You also raised an underdiscussed question: not just who gets trained, but who gets to do each phase of the work: preparation, dosing, integration, and follow-up.
In our prep discussion, you mentioned a model in which veterans support other veterans after psychedelic experiences, almost like an Alcoholics Anonymous (AA)-style [peer-support] community model rather than a sterile clinical one-on-one encounter. Where do you think the field is headed: toward clinical containment, community-based integration, or both?
Will: I think we will move increasingly toward community containment. We will probably start in a more traditional, conventional, clinical framework. But as people understand the role of community in wellness, I think the field will shift.
We have ample evidence that long-term wellness and longevity are supported by deep, meaningful, and nourishing relationships. We are social primates. We need relationship. It is medicine.
Community support is also far more cost-effective than building large clinical frameworks. My hope is that we move toward a mentorship model, similar to AA: “I have been through this. Now I am ready to help you get through this, because I have been through it.”
Lia: I agree. One thing I appreciate is the increasing value placed on lived experience [knowledge gained through direct personal experience]. We need to connect with people who understand the struggle, who are a little further down the road, and who can show that there is a path forward.
You have a goal to train 10,000 clinicians. If the field reaches that kind of scale, what does psychiatry and behavioral health treatment look like?
Will: If the goal is sustainable wellness, things become both simpler and more complex.
The simplicity is that we have to cover the fundamentals of wellness:
- Sleep
- Nutrition
- Relationships
- Hydration
- Physical activity
- Fresh air
The complexity comes quickly because we are then looking at social equity, access, environmental issues, and pollution. It is a fallacy, more extreme in mental health care than in physical health care, that treatment can replace those fundamentals.
I look to countries in Northern Europe, including the one where our friend Floris lives, where the statistics are better on many health parameters than in the United States. It is devastating to see how much we spend on health care in the United States and what the return on that investment is.
Lia: The data make that visible. In countries or jurisdictions where more social models of healing are funded and encouraged, you see better mental health.
One conversation that keeps coming up is the extreme individualism in the United States, especially over the past few decades. Community, contribution, showing up for one another, support, and connection have been through-lines in humanity for the long haul. Recently, the focus has shifted toward the individual: your goals, what you want, your dream. The “I” has come at the sacrifice of the “we.”
What I hear in your vision is a behavioral health system and community that encourages, fosters, and may even require more of the “we.”
Will: Yes. One hundred percent.
Audience Q&A: Certification, Reimbursement, and Evidence
Lia: Let’s shift to audience questions. Jim Smeeding, an expert in pharmacology and drug development, asks: Is there a move toward practitioner certification within this educational process?
Will: We have offered an internal certification for some years. There are also organizations trying to develop national certification, and Lia probably knows more about those efforts than I do.
It is a little like taking psychotherapy to the FDA. There is not much precedent for national certification around schools of psychotherapy. You become a psychoanalyst by going through psychoanalytic training, and psychoanalytic organizations provide certification. You can go to an Eye Movement Desensitization and Reprocessing (EMDR) training [a psychotherapy approach often used for trauma] and become EMDR-certified in a couple of weekends.
It is relatively new to think about going national with a particular school of thought in psychotherapy. But organizations are trying to do that, and I think it is an important movement.
Lia: Some drug developers issue certification for their drug to be administered, which many people would consider inadequate for these forms of treatment. Several groups have tried to create national certification, but this is grassroots work and does not always unfold linearly.
Many people are doing training and offering certification. It will be interesting to see what the system adopts and what gets written into policy, including reimbursement and licensure. There is no single global solution yet. The field is still working this out in real time.
Jim also asks: Is treatment failure the first step in achieving insurance reimbursement? What have your experiences been with pushback from insurance carriers, and how successful have you been in achieving reimbursement?
Will: If we look at Spravato, which is esketamine [the left-handed form of ketamine] in a nasal spray for treatment-resistant depression and major depression, it is a useful example because it has a Risk Evaluation and Mitigation Strategy (REMS) [an FDA-required safety program].
For Spravato, third-party payers [insurance companies or other entities that reimburse care] have required documented failure of at least two medication trials. That could become a model for reimbursing psilocybin or other psychedelic products for treatment-resistant conditions.
I am not sure how I feel about narrowing the funnel that way. It means people may not have access unless they have a treatment-resistant condition defined in that particular way. Many people would prefer an interventional model with one, two, or three drug exposures rather than taking a medication every day.
Still, treatment failure could be a pathway to reimbursement. My psychedelic therapy experience in my office has been more with racemic generic ketamine [a form of ketamine containing both mirror-image molecules], and that has been cash pay. We can get some reimbursement for psychotherapy codes, but we have not been able to get the whole treatment covered.
Lia: Jim also asks whether good ongoing data and outcome studies are underway to demonstrate success and societal benefits from using these new agents with therapeutic support.
Will: We are at the front end of that process. To improve society, we need much more data.
We have lower-quality data, qualitative data, and interview data: people talking about one or two psychedelic sessions causing lasting or permanent personal benefits. Right now, most research is focused on establishing indications [approved medical uses] for major diagnoses. That is where the bulk of the research is at the moment.
Experiential Training, AI Tools, and Access to Practice
Lia: Lynn Marie Morski, founder of the Psychedelic Medicine Association, asks: What are some ways to address the need for greater access to experiential or practicum-type experiences [supervised hands-on training] for trainees on both the therapy and medical side? She also asks for your thoughts on using artificial intelligence (AI) models, such as Fireside’s Lucy or the AI model Sabba is developing.
Will: The need for experiential education is substantial. We have included it in our programs in the past, and it is not easy to pull off. It is expensive and complicated, with a high liability risk.
When clinicians enter this work, they realize there is a lot to learn. Many want their own experiences so they can speak from experience. As Lia mentioned earlier, one’s own experience often becomes part of the conversation: Have you had trauma? Have you taken a psychedelic before? Do you know what that feels like?
It is a vulnerable choice. I do not have a quick answer on how to increase access, but I agree that experiential learning is incredibly valuable.
Lia: I would say it may be essential. Regarding Spravato, the delay was not due to non-reimbursement. It was delayed because practitioners were afraid to administer it without experiential training. That is rational. I would not want to administer ketamine to someone if I had not sat with someone, been supervised, and known what to expect.
I hope people have that same caution before thinking they will sit with someone using psilocybin without experiential training. I love Alicia Danforth’s analogy: you would not want to learn scuba diving from someone who had never scuba dived. It can be dangerous.
Donna Bzdil, a Licensed Clinical Social Worker (LCSW) and interventionalist, asks: How do we get trained? When is the next session available?
Will: Please go to psychiatryinstitute.com. You will find the information there. We are currently registering for a September cohort.
Lia: Lynn Marie also gives a shout-out to you, Will, and thanks you for helping the Psychedelic Medicine Association with its training accreditation program.
Rick Barnes, who is a sober companion, asks: Do you have a medicine of choice, or do you find that certain psychedelics treat specific issues better?
Will: The short answer is no. The longer answer is that each medicine has unique benefits.
For acutely suicidal people who may otherwise need hospitalization, intravenous ketamine can be a strong emergency option. Often, though not always, it can have a major immediate impact on suicidal thinking.
For durable, long-term benefits in depression, psilocybin is emerging as an important tool. Lysergic acid diethylamide (LSD) is also close behind; last week, top-line data from the phase 3 trial of MindMed’s MM120 showed a large reduction in depression symptom scales.
For trauma, I think MDMA therapy will probably emerge as the most supportive option, with highly durable outcomes. They are all different.
Lia: Some medicines may be better suited to some indications than others.
Natural Medicines, Iboga, and Traditional Knowledge
Lia: We are out of time, but I want to include one final question from Elise Fried, a filmmaker, philanthropist, and champion of women’s organizations.
She asks: How do we identify the ailments for which natural medicines [plant-derived or naturally occurring psychoactive compounds] may be useful instead of pharmaceuticals? There is a lot of oral tradition around this. Who is gathering that information, for example with iboga? How are we gathering existing international data, and how do we understand natural medicine versus pharmaceutical approaches?
Will: We have a lot to learn about iboga and ibogaine. To return to your phrase about building the plane while flying it, I hope we take our time trying to understand this plant.
It is incredibly complex, more complex than any other psychedelic by far. At least 50 receptor systems in the brain are impacted by iboga.
I studied anthropology in college and read ethnographies from around the world. I think we need to listen to the local people in Gabon. We need to understand how West Africans have come to understand this plant. That is a good place to start.
Lia: I agree. Thank you for that answer, and thank you for being with us. This has been a wonderful conversation. Thank you for sharing your wisdom and for all the work you have done and continue to do.
Will: Thanks, Lia, for having me. Thanks to everyone for showing up and asking such great questions.
Lia: We look forward to seeing everyone in September for our next Insight Session. Have a great rest of your day.
