Psychedelic Therapy and Underserved Communities with Irina Alexander

Access to psychedelic therapy has increased over recent years. The results of their treatment for various mental health conditions have been promising. However, does increased accessibility mean everyone benefits? We spoke with Irina Alexander to understand the rising popularity of psychedelics in meeting the needs of underserved populations.

“Our work is so relational. It’s not about access in and of itself. It’s about access, safety, holding, and the container. The preparation and getting to know the person becomes the therapy itself.”

— Irina Alexander, LMFT

Irina is a co-founder and Clinical Director of Alchemy Community Therapy Center, an Oakland-based sliding-scale psychedelic therapy clinic. She also works as a street-based harm reduction therapist with the Harm Reduction Therapy Center in San Francisco. 

Irina has a long history of direct service work and believes in the healing capacity of showing up for each other, individually and as a community. She is passionate about making psychedelic healing services more equitable and accessible to underserved communities. Irina has volunteered for several years as a supervisor with the Zendo Project. She is currently also working as an Adherence Rater for MDMA clinical trials.

She is one of the instructors for the course Psychedelic Therapy For Underserved Populations: Assessing Risks & Benefits.

Irina’s Entrance Into the Psychedelic World

Irina first entered the psychedelic world through drug policy reform. She was involved in the Students for Sensible Drug Policy (SSDP) program. At the time, she felt pissed that people couldn’t smoke weed. She was angry that they didn’t get to decide what they could put into their bodies. Then, she learned about the War on Drugs.  Irina shared:

“When I found out about [the War on Drugs], my brain exploded into a bunch of tiny little pieces. I was very naive back then, like a baby teenager, when I started doing that work. [I just thought] we needed to tell people about what’s happening. If we told them how bad it was, then we’d stop the war on drugs. That’s it.”

But realizing the truth after a couple of years of getting involved in the movement, her sparkly eyes dimmed. There were a lot of systemic issues. She saw the realities that we’re facing—such as racism, sexism, capitalism, and all the systems that were negatively impacting society. She learned why people were working that way and how heartbreaking it was.

Contrasting Worlds: Zendo Project and Outreach

Irina started volunteering for the Zendo project through MAPS. She would go to festivals and events to offer harm reduction support for those who were having difficult psychedelic or mental health experiences. 

She was also working as an outreach counselor on the streets of San Francisco. Irina would go around with a backpack. She’d offer supplies and lend an ear to anyone who needed someone to talk to. She mainly worked with young adults left behind by all the organizations or deemed “too hard to work with.” Irina shared that these weren’t the typical homeless white kids with a dog and a backpack. 

At Zendo

She was working in two simultaneous worlds that had contrasting ways of treating people. At Zendo, she was mainly seeing white kids with money. They would get brought in by the cops. The cops would say that the person is having a hard time, and Zendo can offer the help they need. Irina said:

“[At Zendo], I saw what it looked like for someone to actually be supported in an environment that gave what they needed [such as] water, food, someone to talk to, unconditional support, and non-judgmental listening.”

At Her Outreach Job

Then, she would do her outreach job and work on the streets of San Francisco. Irina shared:

“[At my outreach job], I saw mostly black and brown youth get arrested and thrown into jail. This continues to be the number one source of mental health treatment in San Francisco…just locking people up.”

“I have certain clients I’m working with whom I’ve been preparing for ketamine therapy for three years literally.”

— Irina Alexander, LMFT

Irina was frustrated by how differently people were treated in these two worlds. It was partially because of the drugs they used. Still, mainly due to the way they looked. Irina said:

“I was angry to see how much people were benefiting from psychedelics and from psychedelic support in one world and how much people were being targeted, incarcerated, and killed for using drugs in another world.”

Irina shared that her own personal psychedelic experiences have been very transformative. Through that, she helped start up Alchemy Community Therapy Center in 2019. Back then, it was called Sage Institute for Psychedelic Therapy. Irina shared:

“[Starting the Alchemy Community Therapy Center] was an attempt and still continues to be an attempt at bridging those two worlds and giving access that’s equitable to communities that are largely underserved and overlooked.”

Irina’s Split Stance on the Increasing Popularity of Psychedelic Medicines

In recent years, there has been a massive surge of interest in psychedelic medicines, so it’s natural to assume that access has also improved. We asked Irina about her thoughts on how their popularity has affected access in terms of treatment settings. We also wanted to know if there have been any consequences due to this rising popularity. 

Ending the War on Drugs

Irina shared that, on the one hand, she believes in ending the war on drugs, and the increased popularity of psychedelics could help achieve that. Irina explained:

“I believe in drugs being legally available to people in a way that doesn’t criminalize them…They know that it is safe for them, where they are supplied, what they’re getting, the drug education around how to take them, how much, and where to reach out for support as needed…that is a world that I truly believe in.”

Ketamine Therapy Not Structured Through a Harm Reduction Lens

However, Irina also talked about how open access has affected the framing of ketamine. Irina stressed:

“[Ketamine therapy] is framed very much without discussing the risks…[nowadays] this so-called therapy is looking more like ‘here is some ketamine sent to your house in the form of lozenges. Take this, and you will feel better.’ That’s not structured through a harm reduction lens.”

She shared that a harm reduction approach provides people with all the information they need to make safe decisions for themselves. Unfortunately, it’s framed only by looking at the positive aspects. This limited perspective becomes a scary intersection of psychedelics and capitalism, where companies focus on making a profit. 

Drug Companies Are Too Focused on Accessibility

Irina shared that she recently started seeing a lot of Facebook and Instagram ads for ketamine. Specifically, she mentions one ad campaign that promoted the message: Become your silliest self again. Irina shared:

“It’s mind-blowing to see these ads. I’m thinking back to the many sessions I’ve had with clients where they’re accessing deep trauma material that’s coming up for them, and it is not a silly time. That is not the word that I would use to describe it.”

She explained that in preparation with her clients, she talks about how accessing positive, playful, and joyous emotions is important for trauma healing. However, that’s only one piece of it. Irina said:

“I feel like so many of these companies are just focused on accessibility, getting the drugs out, and not focused on safety and how to do this in an equitable way.”

Irina explained that an equitable approach would incorporate drug information, allowing people to have the autonomy to make their own decisions from an informed place and provide support that is culturally relevant, safe, and tailored to their life circumstances. 

She shared that companies provide checklists to clients that aren’t appropriate for underserved populations. Questions like, “Did you take a bubble bath? Did you clean a room?” do not see the human first. It paints a very broad picture of what the experience will be like and makes a lot of wrong assumptions.

Using a Collaborative Approach Instead of a Fast-Paced Model

Irina shared that in her course, she trains healers to use a collaborative approach with their clients instead of working with assumptions. She encourages them to get to know their client and understand the world they live in. She explains that this fast-paced model that focuses only on accessibility skips an entire layer of building a relationship with our clients. Irina explained:

“Our work is so relational. It’s not about access in and of itself. It’s about access, safety, holding, and the container. The preparation and getting to know the person becomes the therapy itself.”

The Goal Isn’t Ketamine Therapy. It’s the Health and Well-Being of the Person

Irina shared that access-only models aim to give people ketamine therapy. However, the goal should be about the person’s health and well-being. This focus on well-being is especially true for the way we train and hold the work for underserved communities. 

She spoke about how the entire preparation process helps build the foundation for a person to live a happy and healthy life. Hopefully, they’ll build enough of a foundation to be able to receive ketamine. It’s not preparing for the therapy. Instead, the preparation becomes the therapy itself.

The Importance of the Social Work Aspect of Therapy

Irina told us that many therapists and clinics don’t focus enough on the social work aspect of therapy. She gave some examples of things we must consider as part of the preparation process:

• Does this person have food? 
• Do they have safe shelter?
• Do they have money to access integration services?
• Do they have a community around them for support?
• Do they have an education level to take in the information about what this all means?

Irina expressed concern that most of these organizations are glossing over these details and making assumptions about this population.

What Healers Need to Understand When Treating Underserved Populations in the Psychedelic Space

We asked Irina for key things that providers need to understand and practice when treating underserved and systemically oppressed populations within the psychedelic space. 

Ask Yourself: Do You Want to Be a Therapist?

Irina shared that she wants people to consider whether or not they want to be a therapist before becoming a psychedelic-assisted therapist. Irina explained:

“There are so many people who come into this line of work after having a big psychedelic experience themselves. They go in with this angle [that they need to] help other people also have a big psychedelic experience. That becomes the goal as opposed to…do they want to be a therapist? That might not be the right fit for everyone.”

Understand What Preparation Looks Like for Underserved Populations

Irina explained that the preparation process with underserved populations can sometimes take years. This extended timeline is especially true for folks who are on lower incomes. They might not have as much access to resources and support. Irina adds:

“People talk about doing three KAP (Ketamine-Assisted Psychotherapy) sessions. I have certain clients I’m working with whom I’ve been preparing for ketamine therapy for three years literally.”

She explained that preparation takes years because she’s building foundational pieces such as safe housing and food. If her client doesn’t have these basic needs, Irina will step into the social worker role. She would help advocate for them to get these needs met, and that becomes the therapy.

Don’t Become a Therapist Because You Only Want to Provide Ketamine Treatment

Irina shared that if people sign up to do this work because they only want to provide ketamine treatment, they’re going to miss out on clients who aren’t ready for that yet or maybe never will be. These folks end up being tossed aside and not receiving the support they need.

She shared that about a quarter of Alchemy’s clients are on active ketamine treatment. However, the majority (about three-quarters) are clients who receive weekly regular therapy. These clients may—at some point—decide to add ketamine as a tool to deepen the therapy work that they’re doing. They don’t kick someone out because they don’t think ketamine is a good fit. Irina said:

“There’s such a disconnected belief system that I’m seeing where more therapists feel like it’s not their job to support clients with basic needs.”

She shared that many therapists and psychologists are going down the path of using a transpersonal lens in their work. They focus on spirituality and studying the subconscious aspects of therapy. They don’t think focusing on the bottom of Maslow’s hierarchy is their job. For instance, a client comes in and says they’re hungry. They’ll say they don’t have food, but they’ll ask how being hungry makes them feel. Irina shared:

“We’re here to support people and to help them follow their goals. It’s not to get them ketamine…that’s what so many of the online organizations are focused on.”