Restoring Meaning to Madness: Contexualising Psychedelic Experience within Clinical Trials
As psychedelic-assisted therapy (PAT) moves from the fringes to the centre of clinical practice, we find ourselves at a pivotal moment in shaping the future of this field. While the adoption of PAT into conventional healthcare settings brings welcome legitimacy, it also raises important questions about how we measure outcomes and define therapeutic success. Clinical trials often rely heavily on quantitative symptom reduction scales, such as the Hamilton Depression Rating Scale (HAM-D), as primary indicators of efficacy. While these tools provide valuable data, they risk reducing the rich, subjective, and often life-altering nature of psychedelic experiences to numerical changes on a checklist.
This presentation challenges the limitations of conventional outcome measurement approaches by introducing a more holistic, context-sensitive framework for understanding psychological distress and healing in the context of psychedelic therapy. Drawing on our direct experience as therapists in the first psychedelic clinical trial conducted in Western Australia, we explore how the Power Threat Meaning (PTM) Framework can offer a more meaningful lens through which to understand therapeutic change.
The PTM Framework, developed as an alternative to diagnostic models of mental health, shifts the focus from asking “What is wrong with you?” to exploring “What has happened to you?”, “What threats did you face?”, “What meaning did you make of your experiences?”, and “What strategies did you develop to survive?” Applied to psychedelic therapy, this framework offers a way of understanding the deep narrative and identity shifts that clients often undergo—changes that may not be captured by standard clinical metrics but are central to the healing process.
We illustrate the application of this framework through two in-depth case studies drawn from our clinical work. Each case highlights the contrast between changes reflected in symptom scores and those observed in the client’s evolving narrative, meaning-making, and relational world. By situating these experiences within a PTM-informed lens, we demonstrate how the framework enhances our understanding of the therapeutic process and helps safeguard the integrity of psychedelic healing within clinical settings.
This presentation speaks to both clinical researchers and therapeutic practitioners. For researchers, we offer practical insights into integrating mixed-methods designs that pair quantitative outcomes with qualitative, narrative-based data. For clinicians, especially those working in ceremonial or non-traditional contexts, we propose a flexible, universally applicable framework that honours both the scientific and spiritual dimensions of healing while remaining intelligible to mainstream audiences.
Ultimately, we advocate for a shift in emphasis—from managing symptoms to honouring process. As psychedelic therapies gain traction within evidence-based systems, we must remain vigilant stewards of their depth, complexity, and transformative potential. Integrating the PTM Framework offers a path forward that maintains scientific rigour while embracing the full scope of human experience that these medicines can catalyse.
Join us as we explore how the PTM Framework can help ensure that as psychedelic medicine enters the mainstream, its capacity to support profound, meaning-rich healing is not lost in translation.
