RGX Peer Support and Harm Reduction Manual – 2020
The information in this document is meant to be a guide for RGX volunteers, orienting the team towards harm reduction approaches and compassionate care. We will discuss various skills and practices intended to create an emotionally and psychologically supportive environment for the patients we see at festivals, and specifically towards those experiencing heightened states of distress. The information here has been gathered from research and experiences from peer-support and crisis services in and out of festival environments.
Harm Reduction is a set of philosophies and strategies aimed at reducing potentially risky activities and behaviors. Seat belts in cars are a harm reduction strategy; condoms during sexual activity is a harm reduction strategy; education around consent practices, fact-based drug information, and drug checking are harm reduction strategies, hiring an on-site medical team at a large public gathering such as a music festival is harm reduction. Think of it as recognizing inherent risks and mitigating or addressing them to create more safety.
Music and arts festivals are environments where people come together to celebrate, dance, and step into experiences outside of their daily societal lives and routines. Some people choose to alter their consciousness with substances at these events with the intention of enhancing their experience. There are many harm reduction practices that are implemented in these environments to increase safety, such as drug checking, free water, condoms, safe usage information, etc. A form of harm reduction we provide at RGX, aside from medical support, is peer support. With all the lights, music, and people around, music and arts festivals are rich landscapes for inspiration and expression. They can also be overwhelming or intense at times, which can lead to some potentially traumatic experiences if appropriate support is not available. In the following sections, we will discuss information and skills involved in giving emotional and psychological support to someone experiencing inner challenges at the festival.
THE RGX SANCTUARY
Adjacent to the medical space is the sanctuary. The purpose of the sanctuary is to create a calm and supportive environment for participants in emotional and/or psychological distress. Having respite from the chaos of an event can be enough to shift an experience from traumatic/overwhelming to calming/healing. Some of these participants will walk up with friends looking for support, some will be brought in by other festival staff, , and some will be discharged from the medical tent once they have been medically cleared and need a calm place to move through their experience. Staffing the RGX Sanctuary is the RGX Harm Reduction Team.
At the core of what we are providing as peer support, it is our presence. How we show up matters. We are practicing the art of holding space.
Holding space means to be present with someone else’s experience with patience, non-judgement, and attentiveness, without the need to “fix” them. It is simply to allow the process to run its course without getting in the way. Giving someone the opportunity to be as they are and feel as they feel fully, while witnessing it with acceptance, compassion, and calmness.
As simple as that may sound, it takes practice and understanding. All to often, we naturally want to help someone feel “better” which can actually create more harm than good, if we deem happy a better emotion than sad. Holding space means welcoming all aspects of the human experience: joy, suffering, anger, insecurities, love, hate, everything. When we hold space, we are saying it’s okay to not be okay right now, and their reasons to not be okay are valid.
Holding space is about walking alongside someone through their own journey, trusting that everyone has their own answers. Certain therapy modalities such as humanistic psychology and Hakomi use this framework and show that the attitude of the therapist/support person towards the individual has a major influence on the individual undergoing intense states.
Important Attitude, Qualities, and Skills for Peer Support
Every person is carrying a unique history and situation and when they come into our care, every situation is different. For this reason, most of how to provide peer support involves how we, the supporters, show up. In this section, we will discuss what qualities and skills we can embody in order to bring the most supportive experience to the participant.
-Grounded and Centered
-Mindfulness (self-monitoring and self-care)
Grounded and Centered – How am I feeling right now? Is my heart beating a little faster? Am I having an emotional reaction to the experience? To be grounded and centered means to maintain a sense of calmness and relaxedness of body and mind. To be thinking clearly, and moving with ease. To feel firmly rooted, comfortable, and safe in one’s body. It also means to uphold a sense of confidence in oneself and in one’s engagement with the interaction. The goal here is to be a solid, assuring anchor for the participant. Calmness is contagious, and so is panic. Zoning out, getting impatient or frustrated, or feeling a sense of urgency are all indicators that one has lost groundedness. Take a breath and do what you need to do to center.
Being Present – Our role is to connect from a grounded place. That can look like many things, sometimes simply just sitting with someone and sometimes engaging in reassurances and conversations. What is happening right now? And now? Presence and connection go hand in hand. That which one is present with is also what they are connecting to. Stay with each moment as the participant is navigating their process. If you recognize you are getting distracted or losing interest, find someone to take over for you.
Non-judgemental – We may hear and see a number of deeply personal experiences unfolding for a participant. Some of those things might be in conflict with our own worldview, belief systems, or opinions. It is important to treat every experience someone presents to us with openness, respect, and acceptance, recognizing its validity. Everyone is doing their best, given the circumstances leading to each moment. It can help to humble ourselves to the profound mysteries of the psyche, of reality, and of consciousness, realizing how little we truly know.
Mindfulness (Self-Monitoring and Self-Care) – In order to keep ourselves in alignment with these skills and qualities, we need to practice mindfulness. That means noticing what is happening in ourselves from moment to moment. If we don’t know we are ungrounded, how can we re-ground? If we don’t recognize when we are losing presence, how can we come back? It is very likely that when something is off in us or when we fall out of our center, it is because we have an unmet need.
Basic needs include eating, sleeping, using the restroom, being warm/cool/comfortable based on weather, etc. When we are being present with another for some time, we can easily forget about these needs and suddenly, we find ourselves being ineffective in caring for the participant. This is why mindfulness is so important. You cannot help others until you have helped yourself. Get backup when you need it!
The role of the peer supporter is to listen deeply and non-judgmentally to the content being explored. Connect with the participant by letting them know you are listening. Reflect what you are hearing and let the participant drive the process. Validate and accept emotions that arise, even negative self-thoughts (“you’re allowed to hate yourself here” can ironically be a very healing experience). Express curiosity and ask clarifying questions to support the uncovering of understanding. Lastly, it is important to mention that the peer supporter should not think they need to “get them talking.” If conversation happens, engage appropriately. If the experience becomes internal, allow it.
Participant: “I lost my friends earlier and I don’t know where they are or where we are camped, or anything!”
Peer Support: “That sounds pretty scary.”
Peer Support: “It is really easy to lose people out there at night, with all the lights and sounds.”
Peer Support: “I’d probably feel anxious too if I lost my friends out here.”
It is likely that some people coming into our care will be experiencing heightened states of anxiety, panic, fear, confusion, or a combination of many emotions at once. In these situations, we must understand the influence of our own state. 99% of the work here is remaining grounded. Take a deep breath, shake or stretch your body a bit, do what you need to do to get calm. De-escalation is about lending our calm nervous system to someone who is experiencing these heightened states. The most important and helpful thing you can “do” for someone else is to ground yourself.
Here are the steps that should be taken should an escalated participation present themselves.
1: Safety – Am I safe? Is the participant safe? Should I back up a bit or move closer?
2: Ground – Am I grounded? How can I ground myself right now?
3: Connect – How can I connect with the participant from a grounded place? What are they trying to express right now?
Connecting is a broad term. Think of it as “meeting someone where they are at.” If someone if feeling/expressing analytical conversations, then to connect would be to analyze together. If someone is in an emotional state, using intellect will miss the mark. Remind yourself what it is like to feel sadness/fear/anger/etc and allow them to feel it. Sometimes connection looks like silently witnessing a person break down, simply showing them they are not alone. Tune in to where the participant is at so you can connect with them there.
Kicking It Sideways
With all these aspects to be aware of, a final important one to remember is: You are human! That means you are not going to get it right every time, and we are all here on this team to support each other! This work can be energetically and emotionally taxing, so when you need extra support, backup, or are recognizing you are not being effective in supporting someone in our care, kick it sideways (get a teammate)!
Situations Beyond the Scope of Peer Support
Medical – If a participant in the sanctuary is showing signs of medical distress such as difficulty breathing, loss of consciousness, chest pain, dehydration, overheating, paleness, vomiting, seizures, etc. get a medic immediately for assessment.
Mental Health – If a participant shows signs of suicidal ideation, psychosis, etc. get the supervisor and Crisis Team Member
Violence – If a participant begins acting violently towards others, the first thing to do is to make sure you are safe. After that, notify the supervisor and they will notify proper safety teams.
INFORMATION ON PSYCHEDELIC CRISES
Everything mentioned before this section is 100% applicable to working with participants in emotional/psychological distress whether they have ingested a substance or not. This section will discuss certain nuances that are important to understand when working with someone who has ingested a psychedelic substance.
Psychedelics and Healing
The process of healing and self growth in a therapeutic context usually involves going into and working with aspects of ourselves that are hard to confront. In entering into therapy, we are creating a clear expectation and agreement with the therapist to work through challenges as they arise, rather than avoiding what is coming up.
What psychedelic research has shown, is that these substances have a remarkable ability to target pathologies of the mind, sometimes from our unconscious, and bring them up to the surface of our awareness. What has also been observed, is that when this process begins, and if supported appropriately, leads to healing at a very deep level of the psyche.
The Inner Healer
The Inner Healer is a concept described by Stanislov Grof M.D., which he discovered in his research in psychedelic psychotherapy before these substances became illegal. Different therapy schools, such as humanistic psychology and Hakomi, all discovered this mechanism and gave it their own names (i.e. the “actualizing tendency,” the “dynamic optimizing thrust of being” or “organicity”). It is the concept that the psyche has its own intrinsic healing intelligence the same way that the physical body heals cuts, broken bones, etc. When conditions allow, healing occurs. A powerful psychedelic experience can bring unconscious material to the surface, such as past traumas, unhealthy patterns of behaviors, harmful personality traits, and more. Once this kind of process emerges, it is important to allow the process to find its own resolution and to avoid premature termination of the process, via drugs that suppress the effects such as antipsychotics and sedatives. Bringing someone out of a process before it comes to completion can have psychologically damaging effects, resulting in unprocessed material showing up in the participant’s life well after the effects of the psychedelic are gone. For this reason, we as peer support trust the process and support the participant to go through even the most challenging of moments, knowing that there are profound insights and gifts hidden in our darkest inner caves. The only time it is appropriate to prematurely terminate the experience is if there is a physiological emergency (assessed by a trained medical professional) or the participant is a danger to self or others.
Presentations of Difficult Psychedelic Experiences
The following is a list of possible psychedelic crises one may witness in working festival emergency services. This is far from defining all of the possible situations associated with psychedelics; however this is a short list of very common experiences seen from the outside. The purpose of this list is to normalize possible presentations that could show up in a crisis so we can continue to remain calm and trust that this is a typical response to the substance and will wear off eventually.
-Looping- repetitive verbalizations and bodily movements taking on a mechanical quality
-Grandeur- “I’m God!” or Truman Show type experience (I’m the star of this show and you are all putting on an act)
-Paranoia- unable to trust anyone, “they are out to harm me”
-Overwhelmed, high anxiety/panic
-Word Salad, Non-Verbal, Sound Making, Glossolalia
-High energy, movement, shaking, somatic experiences
-Hypersexualized content – typically an expression of repressed sexual trauma
-“I am dying.” “I’m never coming down.” “I’ve lost my mind forever.”
Implement the strategies of holding space and embody the qualities and skills defined earlier in this document. Allow and trust the unfolding process from a grounded and assuring presence. Watch your own desires to “fix” the participant’s distress and put them to the side. This stage in the process is just as important as any other. Your presence will be felt and be supportive enough.
A Note on Social Games and Talking
When a participant enters our care they may or may not be able to connect to conversation, depending on how strong the experience they are having is. At first, explore whether words are being received by asking simple questions such as: What’s your name? Do you know what/how much you took and when? Recognize if the participant is wanting/needing conversation. It is normal and okay to be silent as well. Many times, the participant will prompt conversation and express what they need to in connection to the unfolding process.
Psychedelics are well known to lower the “volume” of the ego or completely dissolve it temporarily. In a state where our usual social roles, identities, and programming are gone, it can be distressing, confusing, or distracting to attempt to engage in such ways. For this reason, when supporting someone on a psychedelic, be mindful of your own attempts to engage in an average social experience or “small talk.” Something profound is happening for the participant. Get out of the way and let them be with their journey.
Before saying anything, as the Buddha states, ask yourself: is it true? Is it necessary? Is it kind?
The following phrases can be helpful for someone who is experiencing an intense psychedelic experience. It should be noted that these phrases should not be relied on as a default “what to say” program. These phrases are meant to offer reassurance and invite acceptance. Consider whether it is what the participant is truly needing to hear at that moment. Remember, your presence is more important than your words.
Further Reading on Psychedelic Crisis Care