Dave Hodes
There is a logical need in psychedelics-assisted mental health treatment to have someone with special training work with a patient.
Researchers today like to have that someone be a trained psychedelics-friendly psychotherapist. But who and where is that person? And what credentials should they have? Answers to those questions are in the works.
As far back as 2010, it was estimated that over 30 million people in the United States had at least one psychedelic experience in their lifetime. As many people who have done psychedelics in uncontrolled settings later realized, the importance of human connection with someone who is not experiencing what they are experiencing, but who knows what it’s like, is critically important to not only how the experience plays out but also to their safety during the experience.
The American Academy of Psychotherapists, a multidisciplinary group of dedicated psychotherapists founded in 1955, represents the old school of psychotherapists that did not use psychedelics in their work. They practiced psychoanalysis, used to allow previously unconscious aspects of the “self” to become integrated and help promote optimal functioning, healing and creative expression.
Early psychedelic-assisted therapy was strongly influenced by 50s era psychoanalytic theory. For instance, having a framework for understanding the self is particularly important when working with psychedelic experiences, and psychoanalytic theory offered many such perspectives.
Today there is a new demand in the psychedelics industry to find and develop more “new-school” psychotherapists, who use psychedelics or the psychedelic experience to help them assist patients before, during, and after their psychedelic experience.
A recent study outlined the need: “Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them.”
But developing a training program for today’s psychedelic-assisted psychotherapist has been hampered by the fact that there is not a rigorous definition of a psychedelic-assisted psychotherapy and psychotherapist. The in-training psychotherapist needs to understand “the fact that the expectations and personal experiences of the study subjects are important variables in the response to psychedelic-assisted therapy,” according to another study about psychedelic-assisted psychotherapy. “These variables can be difficult to account for in a clinical trial, but they should be a part of the future research agenda.”
To complicate matters, there is the age-old obstacle about the illegality of most psychedelic substances (mostly in the U.S.) that makes them hard to obtain and use.
The clinical therapeutic approaches to working with people who use psychedelics have remained stagnant, which therefore represents a new challenge for the psychedelics industry—and the industry has responded.
For example, the Center for Psychedelic Therapies and Research at the California Institute of Integral Studies in San Francisco has been training psychotherapists since 2015 in a first of its kind postgraduate certification program. The certificate program trained over 559 licensed professionals from 2016 to 2021, and they are broadening their outreach for greater diversity in applicants for their next certificate course in April 2022.
Applicants can include people with backgrounds in psychological treatment with diverse populations, and/or spiritual direction in: behavioral medicine, chronic trauma and PTSD, palliative care, hospice, psychiatry, drug and alcohol rehabilitation, oncology, mediation, and resolution, and/or pain management.
The MIND Foundation is offering Augmented Psychotherapy Training, a professional training course on the platform of the MIND Foundation’s Academy. After the first program year, a certificate in Psychedelic Integration Therapy/Coaching is awarded. After completing the second program year, participants obtain a certificate in Psychedelic-Augmented Psychotherapy. The program graduate will be certified to practice work in ketamine, breathwork, and psychedelic-augmented psychotherapy.
Vancouver-based Numinus Wellness (OTC: NUMIF) is working on psychotherapy training as a result of their acquisition of Mindspace Wellbeing in 2021; and the Multidisciplinary Association for Psychedelic Studies (MAPS) has been offering MDMA-assisted psychotherapy training since 2005.
Beckley Psytech, headquartered in OxFord, England, a private company dedicated to addressing neurological and psychiatric disorders through the novel application of psychedelic medicines, recently announced the first cohort of psychotherapists training in advance of the expected Phase 2 clinical trial examining 5-MeODMT-assisted psychotherapy in treatment resistant depression.
The initial elements of the training program feature online, interactive, self-taught modules, after which participating psychotherapists will be hosted by the Kadima Neuropsychiatry Institute in San Diego, where the trainers will provide live, in-person training sessions.
This training program is designed to empower psychotherapists to deliver meaningful change to people suffering from severe mental health disorders and provide patients a best-in-class psychotherapy framework inside and outside of the clinic. Over the course of the next year, Beckley Psytech aims to train 80 psychotherapists.
The Beckley Psytech training is being conducted in collaboration with New York-based Fluence, an educational platform that provides professional training in psychedelic therapy for psychiatrists, psychotherapists, social workers, and other healthcare practitioners. Elizabeth Nielson is the co-founder and lead trainer at Fluence.
Nielson et. al. outlined a new model for psychedelics-assisted psychotherapy called Psychedelic Harm Reduction and Integration (PHRI) that doesn’t necessarily include doing psychedelics. It is a transdiagnostic and transtheoretical clinical model that incorporates principles of harm reduction psychotherapy, psychedelic-assisted therapy, mindfulness-based modalities, and psychodynamic therapy. PHRI provides a framework for examining and working with psychedelic experiences in clinical care without providing the actual psychedelic experience as part of treatment. “The psychedelic harm reduction and integration therapy, or sometimes just called integration therapy, can be done in situations where a patient, for instance, says, ‘Well, I want to go take a psychedelic on my own’ or ‘I want to go on a retreat’, or ‘I want to go as part of a ceremony or with friends,’” Nielson told Psychedealia. “But they have experiences that can be integrated into the therapy nonetheless. These can be sometimes difficult experiences and they want help processing them. They have positive experiences and they want space to talk about those. And so this model provides a framework for therapists to be able to bring those experiences into the psychotherapy in a way that’s aligned with harm reduction principles.”
She said that it can be a very rich and rewarding conversation for patients because historically, people who had psychedelic experiences didn’t always feel comfortable talking about those in their psychotherapy sessions. “They could have been stigmatized or they could have been sort of rejected as valid experiences to talk about,” Nielson said. “And a lot of therapists, I would say, by and large, don’t have training on how to approach this conversation. So our model really lays that out for them.”
This new generation of psychotherapists is coming from a handful of different backgrounds who understand some of the processes but need more direction. “We train a lot of clinicians and mental health care providers,” Nielson said. “Some of them have more of a psychotherapy orientation, to begin with, and some of them maybe because of their training and background have more of an approach that’s more grounded in a medical model. So they may have a really great understanding of pharmacodynamics and pharmacokinetics and acute drug effects, but less about the relational qualities of the setting that someone takes the psychedelic in that can really affect the experience. So we really tried to provide a well-rounded training.”
Their approach, she said, is based on having people understand and be able to work with the synergy between the subjective effects of a psychedelic, and the more pharmacological effects of the drugs.
The other part of the Fluence business is about training psychotherapists for psychedelics-assisted therapy work as part of research trials, she said, which is a continually expanding aspect of their work. “As research trials expand and grow from pilots to Phase II to Phase III, they need to train more and more therapists,” she said. “Then many of the drug sponsors need to prepare for, if and when their drug is approved, to create a pool of people who are trained in their modality and can use that practice after approval. So I expect that we’ll have substantial growth in those kinds of training programs as well.”
As the industry picks up momentum, training for psychedelics-assisted psychotherapists needs to match the growth. “I think we have to follow the research and we have to be kind of cautious about the conclusions that we can make at this point,” Nielson said. “But it is wonderful to see that research happening and to see new projects getting started and studies progressing. The training of therapists needs to be happening simultaneously to that, because people’s interest is opened up, and people are having experiences in a variety of settings. I think in general, mental health care providers really need to prepare for that.”
