Q&A: The Importance of Culturally Attuned Care

Because psychedelic experiences are highly variable, it’s important that care providers and participants understand how personal identity can affect the set, setting, and a feeling of safety during a psychedelic experience. This is especially true for people who identify with groups that may be traditionally underrepresented in clinical research, including BIPOC (Black people, Indigenous people, and people of color) and gender nonconforming people.

Pilar Hernandez-Wolfe

Pilar Hernandez-Wolfe

Pilar Hernandez-Wolfe is a licensed therapist with over 25 years of experience. She is also a professor and co-director of the Lewis and Clark Graduate School’s Entheogen Assisted Psychotherapy and Integration Training Series. Her work on decolonization and mental health integrates Indigenous and Western approaches to healing.


BCSP

“What should BIPOC consider when deciding whether to experience psychedelics in a clinical setting?”

Pilar Hernandez-Wolfe

“It’s not about being nice and gentle and having a nice office. People have to understand that BIPOC and gender nonconforming populations might carry with them trauma-based or other terrible reactions in medical settings. Clinical settings can also be off-putting because it’s an office and because there’s no community around.

If you have suffered abuses and misuses of power as a minority, that might be at play, too. There’s also the impact of intergenerational trauma, as well as trauma in that particular person’s life related to abuse. Sometimes people have learned to mistrust professionals, to mistrust police officers, to mistrust people who are authority figures, to mistrust people who have degrees. Sometimes that’s in the general ideology of a community, but oftentimes that is rooted in real experiences of abuse that people have suffered. That’s not just the abuse somebody suffers in their family, but all the other abuses that happen in somebody’s life just because of their social position.

To pursue a clinical experience with psychedelics, I would suggest finding a mental health professional that you know and trust, who is aware that a person might come in with traumatic experiences related to risk, race, class, gender, and sexual orientation.”


BCSP

“How can ethnicity, race, gender, or religion affect someone’s experience with psychedelics?”

Pilar Hernandez-Wolfe

“Gender, class, sexual orientation, and race shape our lives. There’s no way to get away from that. It’s going to play out differently in different social contexts, in different countries, in different geographies. For example, some people who identify as female have fears of going into a psychedelic experience because they’re afraid that men could harm them. If someone doesn’t feel safe, it doesn’t necessarily mean that the setting that the practitioner has put in place is unsafe — it could mean that the person has a higher level of caution. A clinician needs to pay attention to that.”


BCSP

“What should clinicians keep in mind about offering culturally attuned care?”

Pilar Hernandez-Wolfe

“It’s important to ask people: Do you feel comfortable with me — as a woman, as a man, as a nonbinary person — being the provider or the facilitator? Would it be better to have two people co-facilitate? 

There has to be a level of attunement to what people specifically bring into a space. It’s important to ask people: ‘What do you need? Is this safe enough for you? How do you feel with the people who are here? How do you feel with the people who are facilitating? Is anything a red flag for you?'”

“Providing culturally attuned care means that you are aware of what you need to do to build a relationship with that person.”


BCSP

“What is culturally attuned care and how can it help BIPOC clients before, during, and after a psychedelic experience?”

Pilar Hernandez-Wolfe

“From my perspective, culturally attuned care refers to a clinician’s ability to pay attention and relate to a client, both verbally and nonverbally, in a way that’s attentive to their social location. [A term developed by the scholar Kimberlé Crenshaw, “social location” describes how different aspects of identity including race, religion, gender, and sexual orientation intersect with social structures to position individuals in a community, determining who is oppressed, by whom, and how those shifts based on factors like culture, location, history. Although these positions are structurally determined, they also play out in interpersonal relationships.]

There is a level of violence that people from marginalized locations have to deal with in their everyday life that people who have privilege don’t have to deal with. We carry in our bodies a level of cumulative trauma that, in general, people who have privilege do not. When you enter a psychedelic space and you’re not aware of the implications of your privilege and you’re not conscious about your actions and the implications of your actions, you might end up hurting people in many different ways because you have not done your homework. It’s very easy for people of color to come into a psychedelic space and be exposed to microaggressions in a place where they are seeking healing because they have to deal with the ignorance of people who have privilege. This is also true for gender minorities and sexual minorities. 

Providing culturally attuned care means that you are aware of what you need to do to build a relationship with that person. Sometimes that means a more personal chat so they can feel you out and you can feel them. 

For me, for example, it’s very important to ask people about what experiences of marginalization they’ve suffered because of their social location.”


BCSP

“How can non-Indigenous people use traditional psychedelics like ayahuasca or peyote respectfully and without engaging in cultural appropriation?”

Pilar Hernandez-Wolfe

“The Native American Church has been very clear that they really want to protect peyote, and it should be for them. All of us who are not native to this land are basically benefiting from the genocide of the First Nations peoples, so I think that if Indigenous people say, “This is ours,” we have an obligation and responsibility to respect that and not touch it.

With yagé or ayahuasca I would say educate yourself first. Look at the geography. Learn about the people who traditionally use the substance, and what issues their communities face. Educate yourself about the impact of local governments on Indigenous peoples, the impact of capitalism on Indigenous peoples, and ways to help protect the land where these substances grow. Sometimes that means donating, sometimes it means joining a project, but there needs to be a way to circle back. Get away from this mindset of thinking of extraction and think instead about reciprocity. Many Indigenous peoples want to share, but it needs to be done in a respectful and responsible way. You have to think: What’s your impact when you go there? What can you do to give back?”

This interview was edited for length and clarity.

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