Becoming a Psychedelic Therapist | +50 articles

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About psychedelic.training

psychedelic.training is creating free, accessible text and media to assist in conducting psychedelic and complementary therapies. We aim to support safe, informed, and personally relevant psychedelic therapy sessions, as well as to encourage personal development through creative expression and other outlets for inspiration.

Currently, psychedelic therapy faces many barriers in terms of both accessibility and social integration:

- Most places in the world are not home to support systems for honoring practices such as psychedelics therapy, transpersonal psychology, and traditional shamanism

- Without proper instruction, psychedelic use can destabilize their user’s psychology

- Existing clinical psychedelic materials are tedious to find and read, and do not possess the transformative spectacle that leads users to seek psychedelic drugs themselves

- Psychedelic advocacy groups too often overlook or promote risky practices, which can lead to a deterioration of organizational policy and abusive behavior

- Quality of drugs is limited by economic, geographic, and social factors; where trusted sources and testing options are not available, users may ingest of risky unverified chemicals

psychedelic.training aims to help address these shortcomings through Creative Commons-licensed works that enable safe, informed, and therapeutic use of psychedelic medicine, complementary therapy practices, and healing through artistic expression. Our current works include:

- psychedelic.training guides, which are concisely adapted from clinical, traumacentric, shamanic, and anecdotal sources

- Psychedelic therapy training coloring book, which condense our guides into an engaging visual activity book

- Brain research explorer, an open-source neuroanatomy explorer built in Unreal Engine 4, with upcoming VR support

- Therapy & auto-moderation chatbot, an open-source Discord bot written in Node.js with various features: harm reduction instructions, DBT therapy prompts and worksheets, built-in index and directory search features, vote-based moderation, and several other things

- Psychedelic emoji collection, for self-expression

These projects aim to comprehensively cover precautions, therapy practices, integration processes, therapist protocols, and other topics. Citations and additional instructional materials are suggested throughout. Newcomers to psychedelics are encouraged to take the time to explore sources that seem personally relevant.

This project does not intentionally adhere to any organized ideology or tradition, but aims to provide the most relevant and effective instruction available. The goal is to spread awareness of what constitutes safe and informed psychedelic therapy, so that practitioners may safely incorporate this knowledge into their own tradition and line of thought.

If you would like to contribute to psychedelic.training, please join us in our Discord chat.

 
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Veronika Gold

Reflections on my personal experiences as a psychedelic trainer

by Veronika Gold

I am delighted to be a part of the rapidly growing field of psychedelic therapy. In this paper, I share my personal experiences as a participant in a psychedelic therapy training program, discuss the possible benefit of direct experience with psychedelic medicine, and touch on some of the challenges of being a woman on this path.

With the successful completion of the Phase 2 clinical trials for MDMA-assisted psychotherapy for the treatment of PTSD, the start of the Phase 3, and the highly-anticipated rolling out of the FDA Expanded Access program to provide MDMA outside of the trial, historical restrictions on the clinical uses of psychedelics, along with dynamics of privilege and power that have traditionally favored white male researchers, are shifting. We are seeing the emergence of greater opportunities for women to be equally included in the field as researchers and to hold leadership roles. Additionally, study participants are increasingly able to work directly with female researchers.

The protocol for the MDMA study is a remarkable example of how this landscape is changing. The condition of male-female co-therapy pairs as a part of the study design was developed by Annie and Michael Mithoefer, and informed by the work of Stanislav and Christina Grof, Leo Zeff, George Greer and Requa Tolbert, Ralph Metzner, to promote a sense of safety for some participants and to create the setting for potentially emotionally reparative experiences of parental care. However, this was based on assumptions about gender that do not apply for many people. Therefore, the male-female therapy pair requirement will probably not be enforced going forward in Expanded Access, although the protocol will likely continue to mandate the provision of co-therapy, and ideally expand to include non-heteronormative female-female, male-male, transgender and non-binary therapist pairs.

Psychedelic therapy training

As a female psychotherapist deeply interested in the healing and transformational potential of non-ordinary states of consciousness, I have for many years closely followed developments in psychedelic research. While waiting for an opportunity to enter the field, I focused on developing my skills in trauma therapy, becoming a Somatic Experiencing practitioner, EMDR therapist, consultant, and facilitator, and Realization Process Teacher, and deepening my knowledge and practice in contemplative traditions.

It was a life changing moment when I got an email from MAPS accepting my application and inviting me to the MAPS MDMA-assisted psychotherapy training. Not only was I able to step into working with NOSC in treatment and engage in furthering the decades of work that have been spent developing the trial, I was also given an opportunity to grow as a therapist and further my personal healing. Moreover, my relationships with members of my training cohort became an integral part of my life. Our bonds deepened and strengthened as we shared in the collective inspiration and purposefulness of doing profound transformative work together.

For those unfamiliar with the components of the MAPS MDMA Therapy Training Program, I will briefly summarize the stages of training. It consists of several mandatory parts: theoretical preparation through an online course, residential retreat covering topics from the MAPS treatment manual and watching videos of sessions, role-play of sessions, and working with a clinical case in close supervision. Didactic training during the retreat is provided to describe and highlight important concepts of the MDMA-assisted psychotherapy, such as acknowledgement of different ways of knowing and healing, focus on safety and wellbeing of the participant, preparation and orientation to the therapy, creating the appropriate set, setting, and support system for the participant, developing therapeutic alliance and trust, and using an inner-directive approach to treatment guided by the inner healing intelligence (our innate capacity to heal), and the importance of ongoing integration. Finally, there is an optional component of experiential learning, where MDMA-assisted psychotherapy is provided to the therapists in training under the MT1 protocol.

Personal Experience with MT1

I have been in favor of therapists who work with psychedelics having direct experiences with psychedelic therapy, or at least with NOSC. I have personally experienced a variety of non-drug-induced NOSC, including many Holotropic Breathwork sessions. These experiences, in conjunction with more traditional psychotherapy, have been the key component of my own healing of personal and generational trauma and created the foundation of my integral and transpersonal approach to psychotherapy. I have been opened to new ways of knowing, via body wisdom, inner healing intelligence, and non-local consciousness, that have shown me the limitations of talk-therapy, discursive thought and the conventions of language. In MT1 I was finally able to compare the therapeutic value of non-drug- and drug-assisted-therapy sessions on an experiential level.

Therefore, not surprisingly, my participation in MT1 turned out to be a priceless therapeutic opportunity. I gained a new appreciation of the importance of principles I had previously only known as a study therapist: encouragement of inner focus, emphasis on listening to the inner healing intelligence, allowing for plenty of time and space for the processing and integrating material during and after the session, working with uncomfortable and challenging material, and the guiding role of music. Additionally, I was able to first-hand experience the variety of physical and emotional effects of the medicine itself.

Furthermore, I directly experienced the potential value of the male-female co-therapy team from a participant perspective. Gender, I came to understand, even though only one of several variables, is an important factor in the treatment. For example, depending on the gender of my therapist, I observed a difference in my level of comfort and capacity to ask for and accept support. I cherished the emerging balance that their collective presence provided. Receiving the full, undivided attention of the male and female energies and being witnessed, non-judgmentally supported, and cared for was for me healing in itself.

With regard to my own healing journey, the MT1 session provided me an opportunity to look back on my life and revisit painful experiences that have not been fully resolved, seen, and healed, to continue to engage with them, to watch them transform, and to integrate them in new ways. Since emerging from this experience, I have been able to relate to my past with more empathy and to extend more compassion towards myself and my family.  As a result, I believe it made me a better co-therapist and sub-investigator in the study and helped engender a deeper trust for the MDMA-assisted psychotherapy process. I now understand the principles of this type of therapy at an experiential level, and I believe I can relate in a more authentic and unbiased way to my participants’ experiences.

Challenges for women in the field of psychedelic research

As a female, I have been particularly attuned to the social, cultural, and political factors that have deterred women and other marginalized groups from entering the field of psychedelic research. I believe that due to privilege—a built-in advantage distinct from level of effort—white men have been spared from the damaging consequences of racial profiling, stereotyping, and other trends of marginalization and have enjoyed being perceived by and large as the leading authorities in the field. In my own experience, when speaking about psychedelic work alongside male colleagues, people will regularly pay more attention to my male counterpart, regardless of what is being shared and by whom. I would like to see more men being aware of these dynamics and proactively assuming the roles of allies for women and other marginalized groups in the field.

Furthermore, I think that the looming threat of legal repercussions involved in working with Schedule I substances and the consequences of the War on Drugs has also deterred many women from entering the field or becoming visible and has greatly limited diversification of the field. As an example, just within the past year, I have invited two female colleagues providing ketamine psychotherapy to present with me at a conference and write an article on the topic, and both declined due to being mothers and fearing the possible detrimental consequences that presenting publicly could have on their children.

On the other hand, I have been pleasantly surprised by, and deeply appreciative of, the great support of many men as well as women in the field. I have regularly observed my colleagues helping and encouraging each other, exhibiting principles of inclusion, sharing resources, providing each other with opportunities to write and talk at events, and creating space to discuss and process experiences. Inclusion of diverse perspectives, mutual support, and sharing are essential and imperative principles of this new emerging stage of the field of psychedelic research and psychotherapy.

 
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Forging a career as a psychedelic therapist*

by Carey Dunne | The Guardian | 6 Dec 2018

Steve has cops in his family, so he doesn’t tell many people about his work as an underground psychedelic guide. The work takes up a significant amount of his time – around once a week, he’ll meet a client in their home or in a rented home, dose them with MDMA or hallucinogenic psilocybin mushrooms, and sit with them while they trip for up to 10 hours – but he doesn’t tell his siblings, parents or roommates about it, nor his fellow psychology PhD students.

They would probably never guess, either: Steve doesn’t display any signs of involvement with a stigmatized counterculture that many Americans still associate with its flamboyant 1960s figureheads. He’s a bespectacled, soft-spoken former business school student who plays in a brass band and works part-time as an over-the-phone mental health counselor. After one glass of wine, he says: “Whoa, I’m feeling a little drunk.”

But if you probe, he might tell you about the time he took psilocybin and a “snake god” entered his body and left him convulsing on the floor for an hour. ("The snake god was benevolent," he says, "and the convulsing was cathartic, 'a tremendous discharge of anxious energy.' ")

In early October, Steve attended a Manhattan conference called Horizons: Perspectives on Psychedelics, which bills itself as the world’s “largest and longest-running annual gathering of the psychedelic community.” I went with my 51-year-old cousin, Temple, a relatively mainstream psychotherapist. She had come to learn more about psychedelic-assisted psychotherapy, which underground guides like Steve facilitate illegally. She hopes to incorporate this type of therapy into her practice if and when substances such as psilocybin, MDMA, LSD and ayahuasca become legal.

Like many attendees, Temple had recently read How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, the book by Michael Pollan. It convinced her that psychedelic-assisted psychotherapy “might really be the way of the future.”

Indigenous people are believed to have used plant-based psychedelics for millennia; now, factions of the western medical establishment seem to be catching on. But most psychedelics are still Schedule I controlled substances, in the same category as heroin and cocaine; possession or sale has been punishable by prison sentence since 1971. With rare exceptions, the only way you can legally consume psychedelics in the US is as a participant in one of a few clinical research trials conducted at universities such as New York University and Johns Hopkins.

These studies have yielded astounding results: they suggest that, when administered to carefully screened patients by trained health professionals, psychedelics are safe and potent tools for alleviating PTSD, addictions, cluster headaches, anxiety and depression.

Amid a broken healthcare system and rising rates of opioid addiction and suicide, Americans are searching for alternative paths to healing, which is where underground guides come in. The industry has its share of charlatans, but many guides hold themselves to ethical standards and protocols comparable to those established in clinical settings.

Unlike psychotherapists, however, underground guides have no accredited educational institutions, no licensing and no way to publicly market their services. How, then, does one make a career as a guide?

Steve was one of many guides I spoke to who described feeling spiritually “called” to do this work. Like doctors who provide abortions pre-Roe v Wade, he breaks laws that he believes are unjust; he considers legal violations a risky but necessary part of his quest to alleviate people’s pain. He charges on a sliding scale that ranges from around $15 to $50 an hour.

As is the case with most guides, his own psychedelic experiences convinced him the job was worth the risk.

“During an early guided psilocybin session, I realized I’d never adequately dealt with the pain caused by my parents’ divorce,” Steve says. “There was clearly still this 11-year-old part of myself that was like, ‘I want to be part of a coherent family unit.’ During the experience, I was given this vision – there’s no way to say this that doesn’t sounds silly – but there was this mother figure who was like, half-Vedic goddess, with a million arms and a million eyes, and half-space alien, with gray skin. She was this space mother, surrounded by this space family, and she just beamed to me this incredible welcoming feeling of, this is the divine family that we stem from.”

*Continued here:

 
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A beginner’s guide to intentional work with psychedelics

by Alex Theberge | Apr 25 2019

I get a lot of inquiries from people who are new to psychedelics and are interested in some form of intentional work with psychedelics but don’t know how to go about it.

The key word here is “intentional,” meaning, motivated by a desire for healing, learning, growth, or transformation of some kind. Having a sincere intention and a commitment to working with psychedelics in a purposeful way to address this intention makes a huge difference in how the psychedelic substance works with you.

Some have read Michael Pollan’s new book, How to Change Your Mind, and it piqued their interest in having a meaningful psychedelic experience. Others have heard about the healing benefits of plant medicines, such as ayahuasca, for things like depression and trauma but don’t know what their options are.

This article examines the 3 most common types of intentional work with psychedelics and looks at some of the benefits and challenges of each approach.

1. Psychedelic therapy

There are currently two different categories of psychedelic-assisted therapy available: sessions provided by underground therapists operating outside of the law and psychedelic-assisted therapy provided legally within the purview of a clinical trial.

Above-board or legal psychedelic-assisted therapy currently only exist in the United States as part of FDA-approved clinical trials, although there are others being conducted in the UK and Europe as well. As such, they must adhere to a specific treatment protocol that is approved by the FDA for that specific trial. The basic protocol for how a psychedelic-assisted therapy session is conducted is very similar regardless of whether it is an MDMA-assisted psychotherapy for PTSD trial or a psilocybin-assisted psychotherapy for depression trial. The whole point is to make it reproducible and these trials are mainly being built on the backs of the Multidisciplinary Association for Psychedelic Studies’ psychedelic-assisted therapy training models and research protocols. It is a protocol-based treatment that adheres to the protocols defined in the treatment manual. These manuals are a matter of public record so you can actually read them to get an understanding of how the format works.

That being said there are considerable differences in how the preparatory and follow-up therapy sessions are conducted. These are based in traditional psychotherapeutic models of change and are designed to address the specific diagnosis that is the basis for the research study (e.g. addiction, anxiety, depression, or PTSD). Depending on the study and the mental health issue being addressed, they may use different psychotherapy interventions and include more or less sessions.

Finding a clinical trial

If you want to experience psychedelic-assisted therapy you can either find an underground psychedelic therapist in your area or you can participate in an FDA-approved clinical trial. The entire database of active FDA clinical trials can be found at: https://clinicaltrials.gov and a simple keyword search for MDMA or psilocybin will bring up every active psychedelics study in the USA and also tell you which are actively recruiting participants. The limitations of this are that you need to live near a study site, meet the trial diagnostic criteria (e.g. have diagnosable PTSD) and participate in a fairly lengthy intake process, which can take weeks just to determine if you are admitted to the study and the study itself can take 12–16 weeks. This obviously limits who can participate in these studies quite significantly, which is why so many people are seeking out the underground therapist route.
Expanded Access

MAPS recently applied to the FDA for approval of an expanded access protocol that would allow them to provide MDMA-assisted psychotherapy for PTSD to people that meet the clinical trial criteria but for which there are no spaces available in the trial. This could potentially massively increase access to MDMA-assisted psychotherapy but would only apply for those that have a bonafide diagnosis of PTSD. While a movement in the right direction, obviously this provides access to a very limited population.

And while the legal FDA-approved clinical trials don’t charge anything because they are conducting research, there is no telling what a for-profit company like Compass Pathways, whose main investor actively promotes the importance of creating monopolies, will eventually charge for access to their FDA-approved supply of psilocybin. Looking at Ketamine treatment for depression as a reference, I expect it will be in the thousands of dollars.

Underground therapy

The other group of people providing psychedelic-assisted therapy are underground therapists operating outside the law. These types of therapists are hard to find as they tend to maintain a high degree of anonymity due to the legal risks they are taking and only work with people who are referred to them by a trusted source (note: please do not ask me for referrals to underground therapists, as I am not able to provide these.) Many of them are clustered in the larger metro regions (i.e. New York, SF Bay Area, Los Angeles, etc.) and are hard to find if you live in a smaller city or a rural area. This makes gaining access to an underground psychedelic therapist really difficult for most people.

Because these therapists are operating outside of a licensure or regulatory framework, there is no oversight and no barrier to entry. Literally anyone with access to illegal drugs and a sofa in their basement can offer “psychedelic therapy.” They don’t need training, they don’t need to actually be therapists. And there are many unqualified people like that operating. Therefore it is important to be very careful when working with an underground therapist and to critically assess their background, training, and supervision. Remember, this is someone that you are going to be opening your psyche to and that is a very vulnerable state to be in with someone. You want to make sure they have impeccable integrity and are highly skilled at working with whatever may come up in a psychedelic session.

Finally, underground psychedelics therapists aren’t cheap either. $1,500 to $2,000 for the initial preparatory session, the psychedelic session and the follow-up session is not unheard of. This cost compensates the therapist for the extensive time involved in providing psychedelic therapy as well as the risks they are taking in working outside the law but it also makes it unaffordable to the vast majority of people.

2. Plant medicine ceremony

A plant medicine ceremony is a completely different ball-game altogether. There is a wide diversity in terms of ceremonial styles but they mostly adhere to 3 common features that make them quite different to psychedelic-assisted psychotherapy and western psychotherapeutic models.

The first and most fundamental difference is that the framework is ceremonial. This means that the experience is held within a framework of spiritual rituals and beliefs. Some of the rituals and conventions found in plant medicine ceremonies include: defining the ceremonial space as sacred, cleansing the space being used for sacred work, invocation of spiritual protections, and the calling of the spirits of the plant medicine and other helping spirits such as deities or ancestors.

Not all ceremonies operate this way but these are common elements found in traditional plant medicine ceremonies in settings as diverse as the Sierra Mazateca, the Peruvian Amazon and the deserts of North America. More importantly, these are some of the elements of plant medicine ceremony that you will typically find in new-age or neo-shamanic “western” ceremonies, even if they are incorporated in a perfunctory manner.

A key feature here is that of spirit. These are spirit ceremonies and by definition have trappings of spirituality. One is not required to believe in spirits or have a spiritual inclination but it is a contextual element that will be present in some form or another. A plant medicine ceremony generally involves engaging with psychedelics in an overtly spiritual setting.

Group experience

Second, a ceremony is typically in a group setting, meaning that several participants ingest the plant medicine together. This is one of the key features of a psychedelic ceremonial experience. It is not always the case but it is the most common format that you will find. Going through an intensive experience with a psychedelic or plant medicine in a group setting creates a very different kind of experience. What the other ceremony participants go through will affect your experience in some way. If held well by the facilitators, this can be a very positive and beneficial experience. However, if poorly managed, it can result in a lot of commingling of people’s personal issues and energies that can lead to confusion as well as delusion.

There is also a deep bonding that occurs during ceremony that enables people to have an experience of true community, sometimes for the first time in their lives. The “we’re all in it together” nature of the ceremonial experience can be quite profound on its own, whether or not one is ingesting psycho-active substances, which is why it is a feature of many spiritual and religious traditions. And in plant medicine circles that meet regularly (e.g. one weekend a month) this can open the doorway to being part of a genuine ongoing spiritual community. That is not something that psychedelic-assisted therapy generally offers.

Actively guided

Thirdly, plant medicine ceremonies are guided and directed affairs. There are no headphones and no eye masks. The individual’s experience is guided to a greater or lesser degree by the facilitators of the ceremony. This can be as lightly guided as someone playing soothing medicine bowls or gentle guitar songs in the background creating the sonic backdrop of the ceremony experience to something as involved as a full-blown shamanic ceremony where the shaman is directing the ceremony via the medicine songs that guide the medicine spirits to do specific types of work and actions and is doing active healing rituals on some or all of the participants using tools such as medicine songs, tobacco smoke, leaf rattles, perfumes, or plant herbs. In these formats, the facilitator is a major factor in the experience which means that the facilitator’s integrity, experience, and skill level are of vital importance.

Preparation & Integration

One final difference is that plant medicine ceremonies typically do not include individual preparatory or integration sessions as you would find in psychedelic-assisted therapy. Sometimes facilitators will hold pre-ceremony meetings that serve to prepare the participants for the upcoming ceremony and/or sharing circles after a ceremony to help participants process and share their experience. And some shamans will meet with or be available to meet with each ceremony participant prior to ceremony to hear about their complaints and identify how to address them. That is more commonly found in traditional shamanic healing settings and not something typically found in the US. Either way, the preparation and integration support is vastly different than having several one-on-one psychotherapy sessions with a therapist to identify the issues to be addressed in a psychedelic-assisted therapy session.

Plant medicine ceremony

Plant medicine ceremonies are held around the US in informal underground settings year-round. Most major cities have multiple ayahuasca circles that meet on a monthly basis and accept new participants by referral. Similar to underground therapists, it can be challenging to find these if you are not connected to alternative health or spirituality communities or live far from a major metropolitan area. And all the caveats for underground therapists apply here as well (i.e. variability of skill and experience of the facilitator, lack of oversight or regulation, low barrier to entry, etc.)

There are also above-board plant medicines retreats held in settings where it is legal (eg Peru, Brazil, Costa Rica) and being led by highly trained facilitators . The most obvious option here is working with a reputable ayahuasca retreat center in the Peruvian Amazon, where it is not only legal but there is a very old tradition of working with ayahuasca for healing purposes (Full disclosure: I used to work at an ayahuasca retreat center in Peru). These week-long retreats are more expensive and involve foreign travel and time off of work. However, they also offer the opportunity to work much more deeply with these medicines under the guidance and direction of bonafide masters of the medicine. As in any other format, it is important to do your research in terms of what retreat center to work with.

3. Solo or private intentional psychedelic trip

The third category of intentional psychedelic experience is one where you are consuming a psychedelic privately for an intentional purpose either alone or with a sitter. Some people choose this route because they’re unable to find a practitioner to facilitate an experience or because they are comfortable experimenting with psychedelics on their own. The main features of this approach are that you are unassisted and do not have the support, guidance, or direction of a trained professional with a lot of experience handling the wide variety of experiences that occur. The settings for these tend to be people’s personal homes or a naturalistic setting. Sometimes these are done as part of a group experience (i.e. a group hike where everyone takes psilocybin mushrooms together) but group experiences tend to make it harder to do deep work since you are regularly being pulled out of your private experience into interactions with others.

True intentional work often involves an inward journey which means that this kind of solo work is typically done with an eye mask, headphones, and a pre-curated playlist of appropriate music to create the desired experience, similar to a psychedelic-assisted therapy session. Some people prefer this route because it offers them freedom and autonomy in their work with psychedelics and offers the flexibility of working with psychedelics in whatever manner one choses. And having a trusted and sober friend sit with them during the experience provides a sense of safety that allows people to relax into the psychedelic experience.

Challenges of solo work

However, there are a lot of challenges with working on one’s own with psychedelics. One of them is getting access to high quality psychedelic materials. Not everyone has those kinds of connections or is able to easily get their hands on psychedelics. And the quality of the material or substance is variable and unknown and appropriate dosing can be very tricky. People sometimes consume too little to enter a visionary state at all or consume so much that they end-up having a frightening and overwhelming experience. And without anyone to guide them through it, an overwhelming state can be traumatic.

I work with many people who come to see me after having a really negative, terrifying, or challenging experience doing solo work with psychedelics. As such I am well acquainted with the shadow side of psychedelics. And while for many people working with psychedelics intentionally on their own will be fine, for others it can lead to psychological harm that they will then need help to address. Unfortunately it’s very difficult to know ahead of time which camp someone will fall in to. However I do find that if you are looking for healing a particular issue or trauma in your life, it is definitely best to work with a professional guide of one form or another.

If one is going to attempt the solo route, going very slowly and very gradually is a safer approach that can reduce the risk of some of the potential harms. Having a sober friend that is familiar with psychedelics sit with you is also an important safety precaution.

Furthermore, I have found that continuous long-term experimentation with psychedelics outside of a community framework that supports it has the potential to de-stabilize an individual’s psyche and that this holds true even in traditional ceremonial work and settings. If you’re not working very hard at integrating these experiences over time it can lead you to feel disconnected from the rest of the world that isn’t on this journey with you. Returning home (or finding your new home) is an important part of any journey and integration is really the “coming home” stage. Going on an extended psychedelic journey can lead one to become really disconnected from ordinary daily life and can make the eventual inevitable coming home much harder.

Conclusion

Working with psychedelics intentionally can be incredibly life changing and transformative when handled responsibly. In the proper hands, its healing, consciousness-expanding, and spiritual growth potential are light-years ahead of recreational uses of psychedelics. And while there is no one right or wrong way to go about it, there certainly are best practices as well as contra-indications for each of these 3 approaches built on years of exploration and experimentation by countless people over generations. Which ever approach you choose, I would recommend studying-up on the best practices of that approach to the extent possible.

And one universal best practice is to work actively and conscientiously to prepare for and integrate a psychedelic or plant medicine experience. This includes reflecting on what it is you really want to address using this substance and making time to process and work with whatever came-up during the experience, either on your own, as part of a psychedelic integration group, or with the help of an experienced professional.

 
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Developing guidelines and competencies for the training of psychedelic therapists*

by Janis Phelps

The trajectory of psychedelic-assisted psychotherapy has been inextricably linked to the social and political forces within which it has been pursued. The research programs in the early decades of the 1950s and 1960s enjoyed flexibility in the exploration of many variables thought to be associated with therapeutic effectiveness. The outcomes of this research in the early years and in the past 25 years have been significant, iterative, and profound. Findings indicate that psychedelic-assisted psychotherapy can significantly increase capacities for coping and making meaning, increase empathy, lessen anxiety and other symptomologies, evoke life-affirming transpersonal/mystical experiences, and enhance the quality of life. The contributions these researchers have made to the betterment of mental health and our understanding of healing in such a short period of time is laudable. The federal restrictions on psychedelic research since the 1970s and 1980s have had far-reaching effects on the types of therapeutic variables studied. Unfortunately, therapist effectiveness and competence variables have not been a contender as an area of focus in the required context of double-blind clinical trials with treatment manuals.

In order to demonstrate efficacy of the psychedelic medicine, therapist variables have often been seen as intervening variables that are necessary to control for in the research design.Therapist competencies have been discussed only sporadically in the wider psychedelic literature, but this review has elucidated identifiable trends in terms of 6 core competencies. The importance of 12 curricular domains of study and guidelines for therapist training was explicated. Should this renaissance continue apace, this compilation of core competencies and training areas of study can serve as a vehicle for philosophical debate, research, and the refinement of the competencies and domains of training elucidated here. Of course, there are reasons that this work is important beyond the tidy design of training programs for therapist guides. Freedom of religion and spiritual practices utilizing psychedelics has been suppressed in the United States. And people with critical medical conditions cannot derive the benefit of accessing the psychedelic medicines. What we may well be preparing for is a redemptive developmental stage in the life of the psychedelic research field, in which perhaps:

"Interdisciplinary research and retreat centers could someday be established at which volunteer subjects who pass medical and psychological screening could receive entheogens. Some might apply to come to such centers for personal, spiritual reasons alone, and have little interest in research. Others might be willing to contribute to research."

The healing and transformational experiences to be found in psychedelic-assisted exploration in therapeutic and supportive sets and settings are a birthright. The diligent and devoted work of the scholars and researchers in this field will be looked upon by future generations as absolutely heroic.

*From the article here:

 
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New online network for psychedelic therapists

by Russell Hausfeld | Psymposia

Alli Feduccia is a Clinical Data Scientist working for MAPS’ Public Benefit Corporation — a for-profit entity owned by MAPS. She is currently working with MAPS to develop a new online psychedelic therapy and integration support network website — psychedelic.support. The website will showcase clinics and providers looking to network with one another and connect with people seeking treatment. This site could soon become a useful asset to anyone interested in the professional world of psychedelic-related therapy.

Feduccia spoke with Psymposia about the psychedelic.support website and how she originally got involved with MDMA research.

How did you end up getting involved with MDMA research?

Alli Feduccia: I first started working here about three years ago. I started as a volunteer, then did an internship, then started working on the clinical team.

I had been studying MDMA in rodent models in grad school, studying serotonin and dopamine release while rats were self-administering MDMA and then putting them in different environmental conditions — like playing music, or increasing the temperature of the cages. The idea being to replicate the rave scene.

I had read about the first MDMA studies in humans starting and I really wanted to get involved. What you can grasp from rat models about psychedelics is limited. I reached out in 2007, but there weren’t any opportunities. I went on to do some more clinical work, studying mainly alcohol addiction and looking at different medications and how they might work to help addictions. I got back in touch with MAPS around this time, and ended up getting a job there eventually.

Where did the interest in working with MDMA come from?

I was working in a lab and we were studying other drugs alongside MDMA, such as alcohol and cocaine. It was surprising in 2004 to see that people were using MDMA in this first clinical trial for treating PTSD. I went on to learn a bunch more about its use in the 1970’s and it made sense to me that the pharmacological effects of MDMA could potentially be beneficial when combined with therapy to help people with processing traumatic memories.

How did you begin working on psychedelic.support?

We met a lot of therapists at trainings and started to see that people were looking for psychedelic integration, or more open-minded providers in general. It is really hard to find these people. MAPS has lists online, but we wanted to take that a step further and use technology to make it easier for people to find therapists by location, and create a way to connect therapists to one another.

In collaboration with MAPS and other groups, we’re publishing documents defining terms like “integration”, and presenting them in a more accessible way to the public and other mental healthcare professionals who may want to get more involved.

Besides listing provider profiles, we’ve listed events for professional training opportunities and integration events. Most of these are in-person in small communities. The hope is that we’ll be able to expand to have more online groups for people who don’t have something in their area. Ten people could maybe join a web chat facilitated by one person.

You said you are working on defining terms like “integration” in a therapeutic setting. What does “integration” mean from a therapist’s perspective?

It can be a lot of different things. People work in different modalities of therapy. As far as why we’re working on honing the definition, there was an article that was recently posted that was sort of like: “Watch out therapists — if you are offering integration, you should talk to your board before doing this.”

The problem was that the writer lumped in integration to mean someone taking a drug and a provider working with them. She convoluted this underground work — where a therapist might be present during an experience with a drug — with something else. Integration is more in line with harm-reduction or talking to someone about an experience they had before.

On psychedelic.support we are requiring providers to agree to a code of conduct, basically saying they are working above ground, not giving illegal drugs, not sitting with people knowing that person has taken a drug. People can now offer ketamine and cannabis if it is approved in their state.

With all this emerging, there are lots of questions from therapists, and we’re trying to focus on making resources more available about what terms mean, what things are clearly legal, and what are not. At some point people may even start going to the boards to get more clarification on these topics.

Looking through the website, I noticed a couple providers in Austin, Texas and one in Asheville, North Carolina. Most therapists are on the West Coast. I was curious if there is any outreach to therapists in the Midwest or central United States. Is it harder to find people in those areas?

So far we’ve invited a limited number of people who we knew. Since setting up the site, people have been asking to be added. We review their resumes and their websites, and make sure they agree to our code of conduct, and then we will set them up. We haven’t done a lot of solicitation yet.

What other features about psychedelic.support are you excited about?

We’re also publishing articles on psychedelic.support. These are written by the providers or other people in the field on a number of different topics — either psychedelics or some sort of personal growth resources.

We want to give a platform for therapists and professionals in the field to talk about what their impressions are, and what they are seeing in therapeutic sessions. As more things become available, just putting out resources and information to the public that is understandable, especially for people who are looking for these treatments.

These articles are a way to help people know more about an individual provider. We link all the articles to the profiles of the writer. That way you might learn more about each person by reading a longer article that they wrote.

In the future I think we will introduce some kind of rating system on the clinics, so people will be able to get a better idea of what the services are like there. I think that is really important information that I would want to know if I were going to spend that much money on a treatment.

https://www.psymposia.com/magazine/psychedelic-support-creates-a-network-for-psychedelic-therapists/
 
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How to become a psychedelic therapist

Kile Ortigo and Alli Feduccia | Mar 14, 2019

As recent trials of psychedelic-assisted psychotherapy enter the last phase of testing, the coming need for many trained therapists and guides seems inevitable. Until recently, the only opportunity to train and work legally as a psychedelic therapist was in clinical trials. That will likely change over time as expanded access becomes the next step for current trials (evaluating MDMA and psilocybin) and if psychedelic-assisted therapies become FDA approved.

Many people are looking for information about psychedelic therapy and opportunities to become guides or therapists after reading Michael Pollan’s new book How to Change Your Mind: What the New Science of Psychedelics Teaches Us about Consciousness, Dying, Addiction, Depression, and Transcendence. Providers are seeking trainings to become more informed about psychedelic experiences. They also want to know how to become certified to administer psychedelics in clinical trials and potentially post approval.

Still, there remain many unknowns about what training programs outside of the drug sponsors will be acceptable by FDA to dispense MDMA or psilocybin post-approval. FDA has never regulated psychotherapy, but medical devices often require training in a certified program. Demonstration of competency and maintaining of the acquired skills is required for compliance with regulatory agencies. Transcranial magnetic stimulation is one example of a specialized device with specific training requirements. It’s not yet known how FDA will regulate trainings for psychedelic-assisted therapies.

When can I offer psychedelic-assisted therapy?

The FDA may approve MDMA for PTSD treatment as early as 2021, as MAPS has projected based on an optimistic (and likely realistic) finding of significant and positive results from two on-going Phase 3 trials. If so, thousands of therapists and doctors will be needed to meet the increased demand and opportunity for greater access. PTSD can be a difficult to treat condition with many individuals not accessing or responding to available treatments, so this call for expanded access will be an exciting opportunity to provide care to a much larger number of people who are currently suffering.

The next likely candidate for FDA approval after MDMA is psilocybin for the treatment of depression. In late 2018, the FDA granted Breakthrough Therapy designation for psilocybin for treatment-resistant depression, which will help expedite its approval as long as results from clinical trials remain positive

What are the options for training in psychedelic-assisted therapy?

Despite many unknowns, some training programs already exist, and many more are expected to become available.

In 2015, the California Institute of Integral Studies (CIIS) started a formal training program called the Certificate in Psychedelic-assisted Therapies and Research. The hybrid residential, in-person and online curriculum is a roughly 9-month course with rotating guest lecturers and a weeklong retreat. This program is broad in focus, interdisciplinary, and covers classic psychedelic medicines (e.g., psilocybin, ayahuasca, peyote, LSD) as well as the newer medicines (sometimes labeled empathogens or entactogens) like MDMA and ketamine.

To enroll in the CIIS certificate program, interested individuals must fill out an application, complete an interview, and receive an offer from the program’s selection committee. Applicants are required to be a licensed mental health or medical professional, counseling attorneys, or ordained or commissioned clergy and chaplains. The tuition cost is currently set at $10,000. There are several information sessions scheduled throughout the year to explain more and answer questions about the program. Each cohort generally starts in the Spring and graduates in December.

More substance-specific trainings also exist. In anticipation of Expanded Access approval, the Multidisciplinary Association for Psychedelic Studies (MAPS) has now posted an application for the MDMA Therapy Training Program with an invitation to apply. Training is currently prioritized for providers who would likely qualify for the Expanded Access program. If accepted by FDA, more clinics will open for MDMA-assisted psychotherapy for PTSD treatment during expanded access. Requirements for clinics and providers are provided as is a forum for providers to connect with others who are interested in starting up MDMA clinics.

While no strict criteria have been released about who would qualify, the MAPS website states that at minimum one person in the therapy team pair must be licensed to conduct psychotherapy. While the other person does not need to be licensed, they “must display training in therapeutic relationship, ethics, and traumas.”

Each clinic also needs a Drug Enforcement Administration (DEA) license, which requires a licensed medical provider who can prescribe (e.g., medical doctor (MD), doctor of osteopathy (DO), or other eligible prescriber). MAPS encourages interested providers to apply now in preparation for the expected post-FDA approval. The cost for training and supervision is currently set at $9,000.

Other industry drug sponsors, such as Usona Institute and COMPASS Pathways, and researchers at various universities have devised their own trainings and ways to prepare clinicians to work on clinical trials of psychedelics. At this time, there are no details posted on websites about what the trainings consist of, but journal publications have described procedures, such as the Usona Guide Manual.

What do you learn in the training programs?

The CIIS program is approximately 180 hours and covers a wider range of topics related to psychedelic therapies. More time is spent on historical and philosophical aspects of non-ordinary states of consciousness, including non-substance induced ones as seen in Holotropic Breathwork and deep meditation. The learning objectives are focused more broadly on psychedelics and empathogens, rather than specifically on MDMA-assisted psychotherapy.

The MAPS program is a 5-part course with didactic training and experiential learning components. Trainees start with online e-learning modules covering MDMA pharmacology and its clinical safety profile, an introduction to the MDMA Treatment Manual, and some basics about clinical trials. A week-long, in-person training follows where MDMA session videos are viewed and discussed with the therapists who treated the study participants. The next parts involve role playing, observing MDMA sessions, and then treating a patient with supervision and evaluation from the trainers.

Some parts of these two programs overlap significantly. For example, the weeklong in-person retreat for both programs focuses on MDMA-assisted psychotherapy and are taught by Michael and Anne Mithoefer, MDMA study therapists and lead instructors at MAPS.

What are the experiential learning components of trainings?

Dating back to the first research studies of LSD in the 1950s, a first-hand experience in a non-ordinary state of consciousness has been perceived valuable for administering psychedelics. It’s thought that by understanding the drug effects, the therapists can more readily establish empathetic rapport and presence to support a person’s therapeutic process. They can also be better able to respect the power and significance of these experiences.

For indigenous communities, it’s deemed essential that shamans or ceremonial leaders have personal experience with the psychoactive plants they give to others. But in Western medical practices, it is rarely the case that doctors are encouraged (or even allowed) to take a medication to understand the effects a patient would feel.

Thus, psychedelics present a new challenge for psychiatric medical training. If there is value in having a personal experience, then how can providers legally pursue an experiential learning component to their training? To date the evidence of potential benefits of doing so remain anecdotal due to lack of approved controlled research.

CIIS’s program is an “above board” program with no use of illicit substances. MAPS, however, received approval in their sponsored, FDA-approved study that allows trainees in their program to receive one dose of MDMA in a clinical setting if they also are eligible for the research study as a participant. As with all clinical trials, participants in the approved study must meet criteria to enroll and provide data to assess potential benefits or harms. Even if they meet the basic inclusion criteria, trainees are not required to undergo an MDMA session. Some might have conditions that would counter-indicate the use of MDMA. For example, pregnant women or individuals with cardiac disease would be excluded. Trainees may also simply not want to take a drug.

As alluded to earlier, Holotropic Breathwork is one alternative to reach a non-ordinary state of consciousness without consuming any substance. Through accelerated breathing and stimulating music, a person can enter into states similar to ones induced by drugs.

CIIS incorporates Holotropic Breathwork as experiential learning in their program. Therapists may consider alternatives, but they should do so while considering carefully the legal and ethical guidelines of their licensing board and professional organizations. Psychedelic Support and its partners do not encourage or condone the illegal use of substances.

Given this reality, other possible alternatives for experiential learning do exist. They include attending plant medicine ceremonies in other countries where it is legal, shamanic drumming/chanting practices, or extended meditation. Research is needed to understand if first-hand exposure by therapists impacts patient outcomes, and if so, what type of drugs or experiences are best for training. We encourage therapists exploring this new area to consult with their colleagues and even seek out legal counsel as they deem appropriate.

What can I do now?


If becoming a psychedelic therapist is of interest to you, then there are things you can do now to help figure out if this path is right for you and if so, prepare for the future. You can start by reading books and articles about psychedelic-assisted therapies. If you want hands-on experience supporting individuals undergoing a difficult psychedelic experience, one great way to do so is to volunteer for harm reduction services at festivals.

Already a health provider? Network with other professionals interested in this topic and attend psychedelic conferences. If you are a clinician, consider joining a Psychedelic 101 and 102 Introductory Course by Psychedelic Support providers, Dr. Elizabeth Neilson and Dr. Ingmar Gorman. Check out our website Psychedelic.Support to view a current list of organizations offering professional trainings related to psychedelics.

Lastly, educate yourself and share what you are learning with others. A new profession is evolving, and more opportunities are becoming available for those who wish to pursue a career in psychedelic medicine.

https://psychedelic.support/resources/training-psychedelic-therapist/
 
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Everything you need to know about psychedelic-assisted therapy

by Donovan Alexander | Interesting Engineering | Sep 13 2019

Psychedelic-assisted therapy is currently getting more and more attention from the scientific community.

The world of psychedelics is exciting, to say the least. As we mentioned in our previous article, newly rekindled scientific research in the world of psychedelics have brought them to the forefront of cultural discussion and debate.

Even just recently, John Hopkins Medicine received $17 million from donors to open a new center purely devoted to psychedelic research.

So, you are probably wondering why there is all this interest in these mind-bending drugs? More and more researchers are pointing to the potential therapeutic benefits of psychedelics.

Even more so, some of these psychedelics potentially hold the promise of treating psychiatric disorders ranging from PTSD to depression. However, there are still a lot of questions to be answered.

The recent scientific interest in these drugs coincides with the underlying interest in mental health. However, it is good to mention that a lot of commonly used psychedelics were once used for treating mental illnesses decades prior to them becoming illegal.

We are going to break down everything you need to know about psychedelics and therapy, and the coming age of psychedelic science.

Introducing psychedelic-assisted therapy

Before we go on our “trip,” it is good to mention that psychedelic-assisted therapy is not where you scarf down a whole bunch of magic mushrooms and hope for the best.

Psychedelics are dangerous, as you can never truly predict how you or your mind may react to the experience, with some experiences exacerbating any existing mental health problems.

Psychedelic-assisted therapy does refer to therapeutic practices that involve the ingestion of a psychedelic drug. However, this is usually in a controlled and safe environment with a therapist present.




In clinical trials, psychedelic therapy is often broken down into 2-3 sessions, with each session lasting around eight hours. However, these sessions are not done back to back, as most researchers or therapists like to space out each session, keeping them about a month apart.

Trials begin with participants talking and building trust with their therapists before taking any drugs. Preparation may also include taking a complete medical history questionnaire and providing information about the study drug. Once the patient has taken a controlled dose of the drug, the process is relatively simple. Participants might be given an eye-shade or headphones while they are “tripping” and talk to their therapists about how they feel.

What psychedelics are used?

Many of the most common psychedelics have attracted the interests of scientists to treat a wide array of mental health issues. Psilocybin has taken center stage, along with other well-known psychedelics like MDMA and or LSD.

A lesser-known substance, ayahuasca, is also becoming more popular in the west. This is a traditional Native American drink made from the Banisteriopsis caapi plant, along with other plants. The drink has been used in indigenous cultures for thousands of years and has more recently become a tool for treating people in psychotherapy centers in Latin America.

What mental illnesses are being treated with psychedelics?

In short, in a controlled and safe environment, psychedelic treatments have been shown sometimes to produce a positive and even lasting behavioral change.

Psychedelic treatments have been shown to have an effect in combating addiction, anxiety related to terminal illness, chronic PTSD, depression, obsessive-compulsive disorder, and social anxiety.




Let’s dive a little deeper.

In a study on using psilocybin to treat anxiety-related to terminal illness, published in the Journal of Psychopharmacology in 2016, researchers stated: “High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism.”

“At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety.”


Another study, published in the Journal of Psychopharmacology in 2012, highlighted how LSD and psilocybin could potentially be used to treat alcohol dependence. Psychedelic therapy has also been linked to the treatment of other mental health issues, including social media addiction.

Other studies have highlighted how MDMA-assisted psychotherapy could be used to help people suffering from various forms of PTSD.

Finally, researchers are excited about psilocybin, as it has consistently shown the potential to help treat people with depression.

What is micro-dosing?

Now, when discussing psychedelics, you have probably heard the term micro-dosing thrown around. It has actually become a major trend among Silicon Valley tech workers searching for ways to improve their productivity.

Micro-dosing refers to the ingestion of very small doses of certain psychoactive drugs, most often LSD, psilocybin, or cannabis. Micro-doses are known as 'sub-perceptual' and are usually around one-tenth of a normal dose. Such a tiny amount is taken that users often do not feel any of the traditional psychedelic effects at all.

In short, the aim of micro-dosing is to trigger a drug’s therapeutic benefits, such as increased creativity or improved mood, without the potentially disruptive effects seen at higher doses, such as hallucinations or dissociation. There are already countless anecdotal testaments to people becoming more productive and changing their lives for the better.




Nevertheless, there is not much science on micro-dosing at the moment. More controlled trials are needed. Some animal studies have also identified potentially negative effects with micro-dosing, such as metabolism that slowed after use, which needs more investigation.

Where can I go for psychedelic-assisted therapy?

Unfortunately, you can not just walk down the street and look for a psychedelic-assisted therapy center. Nevertheless, some of the psychedelics on this list are on the path to being decriminalized, at least for medical uses, around the world.

Because research is highlighting that they do more good than harm, we may see therapies brought into the mainstream. There are places in Jamaica, the Netherlands, and in Latin America that offer psychedelic-assisted therapy. The other way to try out psychedelic-assisted therapy is through becoming part of a clinical trial at a place like the new Johns Hopkins center.

What do you think about the renewed interest in psychedelics?

 
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About the certificate in psychedelic-assisted therapies and research

"Our normal waking consciousness, rational consciousness as we call it, is but one special type of consciousness, whilst all about it, parted from it by the filmiest of screens, there lie potential forms of consciousness entirely different. We may go through life without suspecting their existence; but apply the requisite stimulus, and at a touch they are there in all their completeness, definite types of mentality which probably somewhere have their field of application and adaptation. No account of the universe in its totality can be final which leaves these other forms of consciousness quite disregarded." - William James (1902), The Varieties of Religious Experience

This Certificate Program is housed in the CIIS Center for Psychedelic Therapies and Research at CIIS Public Programs. The Center also provides diverse public education about psychedelic research and the use of psychedelic in psychotherapy from the past decades, as well as teaching on topics such as creativity enhancement, consciousness studies, comparative mysticism, well-being enrichment and harm reduction. Book readings and lectures by scholars of psychedelic medicines have been presented since 2015 and a film series is planned.

The Psychedelic-Assisted Therapies and Research Certificate serves a growing need for the training of skilled therapist researchers who will ideally seek advanced training for future FDA-approved psychedelic-assisted and entactogen-assisted psychotherapy research. Enrollees are professionals in specific mental health and medical professions, as well as eligible ordained or commissioned clergy and chaplains.

The roots of this Certificate are in the work of scholars and researchers on psychedelic-assisted psychotherapies, transpersonal psychology, consciousness studies, psychoanalysis, comparative mysticism, and anthropology. While this Certificate program emphasizes the therapeutic models of psychedelic research, we will address the philosophy and theory from these other scholarly traditions as well. CIIS has an outstanding reputation of 50 years in graduate education that integrates consciousness studies and psychology, including psychedelic studies.

Format and development of the certificate program

The format of instruction and curriculum has been developed by Dr. Janis Phelps, Director of the Center for Psychedelic Therapies and Research, in collaboration with many clinicians and researchers in the field. As former Dean of Faculty for the School of Humanities and Social Sciences, Janis Phelps is well positioned to create a multidisciplinary team of teachers from across the United States and Canada. The certificate training program is conducted during a six month period with a summer break.

Hybrid residential and online curriculum

The certificate program course schedule is comprised of five weekend workshops and one weeklong residential retreat. The curriculum entails 180 total hours of instruction, including 120 of in-class learning and 60 hours of online video instruction, volunteer work and mentoring. This semi-hybrid online and in-classroom program will be a benefit for trainees who come from U.S. regions beyond California and other countries.

The learning environment will be in the form of lectures, small group discussion, experiential learning (e.g., Holotropic Breathwork, role-play, guided imagery, expressive arts, journaling) and applied work in clinical and therapeutic settings. Classes begin March 29, 2019 and end on December 8, 2019. The weeklong retreat in June at the Marconi Conference Center in Marshall, California is done in conjunction with MAPS. The founding trainers from MAPS, Dr. Michael Mithoefer and Annie Mithoefer, RN, will be our retreat's expert instructors. Trainees receive instruction in new clinical applications of ketamine-assisted therapies. A special fall experiential weekend in September will include sessions of Holotropic Breathwork with Diane Haug who is a lead international teacher of the Grof Transpersonal Training.

Many leading psychiatrists, psychologists and therapists from Johns Hopkins University, New York University, UCLA, UC Berkeley, and the University of Wisconsin will be teaching in the program. Stanislav Grof, Ralph Metzner, other CIIS faculty, and Bay Area experts will complete the Certificate faculty.

Philosophy and goals of the certificate

Consistent with CIIS ideals, this certificate strives to encompass all aspects of learning: intellectual/didactic, the personal/experiential and applied (clinical and pastoral work). The research and therapy training will be done with processes embedded in self-reflection, community-building and embodied ways of knowing and mentoring. The global wisdom traditions related to alterations of consciousness (meditation, yoga, fasting, solo wilderness retreats, healing methods, etc.) will play a role in the theoretical underpinnings of the curriculum, as well as being directly enacted as part of the personal/experiential aspect of the training.

It is important to note that at no time will the program promote or require the use of psychedelic drugs in any manner. Students taking the certificate will learn about the competencies required of therapist guides in federally approved medical treatment and psychedelic research.

Institutional partners and council of advisors

Many renowned researchers and scholars have advised and supported the development of this certificate program at CIIS. They represent the prominent U.S. and Canadian research centers that are funded by the Heffter Research Institute HRI, MAPS, the Council on Spiritual Practices CSP and the Usona Institute.

We would like to publicly thank the following key thinkers and researchers for their significant contributions to the development of this Certificate. They co-inspired with the Center's director, Janis Phelps, to bring together a wealth of engaging ideas and training processes as the basis for this program. Thank you to Anthony Bossis and Jeffrey Guss (NYU); Karen Cooper, Nicholas Cozzi and Dan Muller (U. of Wisconsin); Rick Doblin, Michael Mithoefer and Annie Mithoefer (MAPS); George Goldsmith (Compass); Betsy Gordon, George Greer and David Nichols (Heffter); Roland Griffiths and William Richards (Johns Hopkins University); Charles Grob (UCLA); Stanislav Grof; Robert Jesse (CSP and Usona); and Ralph Metzner. Many of these researchers were featured in the influential New Yorker article by Michael Pollan.

We give a deeply felt and hearty acknowledgement especially to Dr. William Richards of Johns Hopkins University and Robert Jesse of the Council on Spiritual Practices and Usona Institute for their tireless, consistently inspired and wise counsel on multiple levels of this certificate training program.

 
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How to trip sit

by Michelle Janikian | Your Psilocybin Companion | Dec 16 2019

A trip sitter is a sober person you trust to keep you safe while you’re under the influence of a psychedelic, and having one along for the journey can make the difference between a meaningful and challenging trip. With a supportive presence, you’re much more likely to release your control to the mushrooms and have an insightful, perhaps even transformational experience. Trip sitters are especially handy for your first few psychedelic experiences, or if you’re planning on taking a moderate to high dose. Yet, many people prefer to have them for all their psychedelic experiences. But how do you trip sit? Are there any special requirements?

Preparation

Trip sitting is fairly simple. The most important thing to remember is to be a calm, nonjudgmental, and kind presence for the entirety of someone else’s psychedelic journey. It’s helpful for trip sitters to have psychedelic experience of their own, especially with challenging trips, but this is not completely necessary. Having that firsthand knowledge can help sitters be more empathetic—without becoming anxious—to the weird range of possible sensations that trippers may go through, but preparing yourself by reading guides like this one can also be enough.

Trip sitting is often referred to as “holding space,” although the expression isn’t exclusive to psychedelics. “Holding space is just being with somebody and allowing them to go through whatever process they need to, without really trying to interfere,” says Jessica Grotfeldt, experienced trip sitter and founder of Luz Eterna Psilocybin Retreats. It’s really just being present for someone, listening or sitting with them in silence, without offering your opinion or any kind of advice.

So how do you get started? First of all, it’s important to have a conversation before the psychedelic experience with the person you’re going to be sitting. You’ll want to discuss expectations, intentions, boundaries, and to set a loose plan so nothing comes as a surprise. If you’ve had a psychedelic experience before, but the person you’re sitting for has not, talk in depth about how mushrooms can make people feel, both mentally and physically. Some experienced sitters even make people “what to expect” fact sheets. Be sure to also discuss the tripper’s intentions: Why do they want to take mushrooms? What do they hope to see, experience, or learn? Discuss any fears or worries they might have and how you plan to deal with any challenging material that might arise. For instance, if the person is afraid they might have a bad trip or be faced with some challenging thoughts or memories, tell them you’ll be there to hold their hand and be a shoulder to cry on if they need.

It can also be helpful to discuss a loose plan for the trip day. Talk about the location where the experience will take place. If they’re planning on taking mushrooms at their home, ask if anyone else will be there: Are any roommates expected to return home during the trip? Any chance of anyone else showing up that you, as the sitter, may have to deal with? If they don’t have any outdoor space at their house, perhaps you want to discuss the possibility of driving to a nearby park or beach toward the end of the experience to connect with nature? It’s also important to negotiate difficult issues, like boundaries, ideally days before the experience. While physical touch can really be helpful for those going through a tough time, be sure to discuss it first and set any guidelines. The key is to make everything as transparent as possible to limit surprises on trip day and let voyagers focus on their experience without lingering feelings of uncertainty.

Grotfeldt says "it’s also crucial to ask if the person you’re going to sit with is on any medications or has any chronic medical conditions." Health considerations like diabetes or history of low blood pressure shouldn’t prevent you from sitting for someone, but should definitely be discussed and planned for. For example, having medications or some sugary drinks around, like Gatorade, should be planned ahead, in the case of sitting a diabetic. It’s also important to know if they have any history of depression or anxiety, and if they’re on any medications to treat it. For example, SSRI antidepressants will lessen the effects of psilocybin, even if the tripper skipped that day’s dose. While depression and anxiety aren’t reasons to cancel sitting a trip, if the person you’ll be sitting for explains a history of violent or dissociative behavior, or a more serious personality disorder diagnosis, then you’re in more sensitive territory. In these cases, it’s best you have a lot of sitting experience or perhaps refer them to a professional guide. Other conditions that are considered dangerous to combine with psychedelics include history of seizures and cardiovascular disease.

One other way to prepare before the psychedelic experience begins is to have a “backup sitter,” recommends Grotfeldt. While it’s not necessary to have two sitters for one tripping person, telling someone you trust what you’ll be doing can be crucial if an emergency situation arises. While sitters have to be prepared to call emergency services as a last resort if something seriously dangerous goes down, sometimes all you need is a backup sitter to support you and help you think of solutions from another perspective. Another situation where a backup sitter could come in handy is if you’re sitting for someone who is physically much larger than you, and they begin to act violently (breaking things, screaming). In this case, you’ll want to have a backup sitter on call who is large enough to help the voyager work through these feelings. Basically, having someone to call or text when things get questionable can help you to make the safest choices for those you’re sitting.

Lastly, it’s important to set aside enough time to trip sit. Medium to high doses of psilocybin generally last at least six hours, with the experience coming on and off in waves toward the end. Therefore, be sure to be available for closer to eight to nine hours to fully support the person you’re sitting for. You’ll be able to tell when their experience is winding down, but they’ll likely still be in a vulnerable and sensitive place. So stick around, help them cook or order some takeout if they’re getting their appetite back, and continue to hold space for them. Let them talk it out if they want, or help them settle into a nice nature documentary or other entertainment of their choice. If they’re a really close friend, consider spending the night with them or at the very least make yourself available to talk on the phone or via text that night and the next day.

Trip-sitting essentials

On trip day your main job is to stay calm, supportive, and present. Trippers are extra sensitive to the environment, including your mood, so remaining centered and smiling at them when you make eye contact helps. Don’t act bored, annoyed, or upset (even if you are) because it can grossly affect their experience for the worse. Many experienced sitters recommend bringing a book so you have something peaceful to do and you’re not repeatedly checking your phone. In fact, some sitters recommend wearing a watch so you don’t need to take out your phone to check the time. While you are there for the person going on a psychedelic journey, don’t completely ignore your own needs. Eat when you’re hungry and go to the bathroom when you have to because, again, the tripper will be able to sense when you’re uncomfortable and that could cause them to feel uncomfortable.

It’s also important to remember that you are not there to guide their trip in any particular direction, but rather to be a nondirective source of support. “Number one, the mushrooms are the teachers,” says experienced sitter and founder of The Buena Vida Psilocybin Retreats Amanda Schendel. “We are not there to counsel or guide someone in a specific direction or to ask them pointed questions. We’re just there to keep everyone physically and emotionally safe and to be a support if someone needs it. So I train people to speak as little as possible and to never insert themselves into someone’s experience.” If someone wants to talk, listen, smile, nod, put your arm around them, offer them a tissue if they’re tearing up, but don’t give advice or anything too opinionated.

It’s also crucial never to be condescending or patronizing in any way. Don’t talk to trippers like they’re children or like they’re stupid because that can really send people into a negative place. If they’re your close friends, talk to them as you normally would, perhaps more sparingly. It’s also common for trippers to want to be left alone, and that’s totally fine. It absolutely doesn’t mean they don’t need you anymore and you can leave, because having someone around that’s sober, who they can trust, will still be a pillar of support. Instead, discuss this the day before. Tell them it’s common to want some alone time, but if that happens, suggest they go into another room and leave the door ajar so you can periodically check in on them without disturbing them.

However, sometimes when trippers are alone, they can go through some of their most difficult inner material. When you poke your head in to check on them, you’ll be able to tell if they need some support by their breathing. If their chest is going up and down rapidly, they’re probably struggling, and it’s a good time to sit next to them and just hold their hand. You might not even have to say anything, but often a supportive, gentle touch can go a long way. People may not communicate their needs because they’re too far gone, so you can ask, or just offer them things like a thick blanket, a glass of water, some tissues, or just a hand to hold.

People may also need help with things like going to the bathroom or getting up to walk around because their bodies feel so differently. Everyday things can be a struggle, like changing the music or putting on a movie or video games, so if they express interest in one of these activities, offer to set it up for them. Even adjusting the volume of music or the brightness of lights can be difficult when on mushrooms, so that’s your job as trip sitter.

How to help someone through a challenging trip

Likely, the most difficult thing you’ll encounter as a sitter is helping someone through an emotionally challenging experience. As we’ve been discussing in this book, mushrooms can bring up distressing emotions, past traumas, unresolved guilt, or grief among a host of other tough and even otherworldly experiences. But resisting these inner struggles only makes a challenging trip more difficult. That’s why The Manual of Psychedelic Support recommends that sitters talk trippers through these challenging experiences rather than talking them down or out of them. In fact, the Multidisciplinary Association for Psychedelic Studies (MAPS) teaches sitters to encourage trippers to “explore all emotions, even difficult ones.” Once trippers relax and let all of their emotions flow, they’ll stop resisting the experience and likely find incredible insights, deep inner peace, or even transcendence on the other side.

The best thing a sitter can do for a tripper going through a difficult experience is to just be there for them. Sit down next to them and only talk if they want to. Again, physical touch might help, so hold their hand or touch their shoulder if you’ve already discussed beforehand this is something they’re comfortable with. Offer them a blanket to snuggle under, some tissues, or a glass of water. Make eye contact, smile, and act empathetic and understanding, not worried or concerned (even if you actually are). Grotfeldt tells me "the best thing you can do for someone having a challenging trip is to help them connect with their breath. Take deep breaths with them and if they’re able, try doing some simple breathwork."

Grotfeldt recommends pranayama breathing, which is inhaling for three seconds, holding for six, and exhaling for nine. Count for them gently and hold their hand if they want. Grotfeldt also tells me "it can help to have trippers take their shoes off and touch their feet to the ground while breathing deeply." If they’re really struggling with something and don’t want to sit with it, suggest taking a little walk, even if it’s around the room. “People just need to move their energy in a way that helps distract them,” Grotfeldt says. “If they’re unable to walk, breathing with their feet on the ground and reminding them that you’re there and that you’re taking care of their physical body helps.”

Sometimes a challenging experience looks more like a person being very confused. People can forget who and where they are or think they’re dying or going crazy. Trippers can also get paranoid and might project this onto their sitter, thinking you’re talking about them, conspiring against them, or that you even tried to poison them. The key is to remain calm and kind in all situations. If people are very confused, using their first name when you talk to them can really help. If they think they’re dying or going crazy, remind them that they took magic mushrooms and that the effects will begin to wear off soon, and of course, that you’re there for them no matter what.

Sometimes people on mushrooms get stuck in negative thought loops that are hard to get themselves out of or resolve. So if you notice this as a sitter, you can try to introduce some distractions like beautiful, colorful, or sparkly things to look at together. You could try to watch a nature documentary together, go for a little walk, or get up and move the body by shaking or dancing. The classic recommendations are to change the scenery, music, or lighting; these alterations can help change a tripper’s mood quickly. Do an activity together if they want, like making art or banging on a percussive instrument. The best thing you can do is to remain calm, centered, chill, and friendly. Don’t get stressed or anxious or try to fix everything. Sometimes people just need to cry it out for a while, and it’s a very healing and cathartic experience. Don’t make a big deal of anything, even if they spill something on you, throw up, or wet their pants. Just remind them it’s all part of the experience and help them clean up while remaining positive.

Trip-sitting basics

Do:

- Be supportive yet non-directive.
- Be soft-spoken and gentle.
- Smile and make eye contact.
- Be understanding and kind.
- Be willing to talk but more willing to listen.
- Be willing to change and turn music on or off (and always respect their choices).
- Help with movies, video games, lights, and handle other electronics and technical tasks.
- Get snacks and drinks. Order pizza or help make food toward the end.
- Offer tissues, blankets, and distractions if you feel they’re needed.
- Be willing to call emergency services as a last resort.

Don’t:

- Be condescending, aggressive, annoyed, or stressed.
- Bring up negative, tough memories or emotional topics.
- Dismiss anything they say as worthless, stupid, immature, or “just the drugs talking.”
- Ask them if they’re feeling it, how they feel, or probe them about anything too often.
- Make a big deal if they have an accident, spill or break something, cry, talk too loudly, have a hard time, throw up, etc.
- Have other drugs on you in public.
- Ignore them or leave before the trip concludes.

 
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Why more therapists need to learn about psychedelics—now

by Erin Hiatt | Double Blind | 31 Jan 2020

Ten percent of Americans have tried a psychedelic—but are mainstream mental health professionals prepared to help them after their trip?

With an uptick in the microdosing trend, the decriminalization movement, federal psychedelic research, and media like Michael Pollan’s How to Change Your Mind, more people are becoming curious about the mental health applications of psychedelics.

But despite the public’s growing curiosity around substances like mushrooms or MDMA, there’s a gaping hole in the medical model, whereby mental health professionals may not be adequately equipped to help clients—who may be experimenting with psychedelics on their own time—integrate their often profound, ineffable experiences into mundane life.

We know that 10 percent of the U.S. population has tried psychedelics at some point in their life, and I’d venture to guess that the number will increase,” says psychologist Dr. Ingmar Gorman, who, along with fellow psychologist Dr. Elizabeth Nielson, co-founded Fluence, a newly launched program to train mental health professionals in psychedelic integration.

Simply put, “psychedelic integration” is a growing field of psychology that helps people glean insights from their psychedelic experiences in order to use them as tools for growth. While integration can include practices like yoga, journaling, meditation, mindfulness techniques, or listening to music that was heard during the psychedelic trip, the idea is to help individuals tap into their inner healer.

Gorman describes psychedelic integration as a transtheoretical approach that highlights a therapeutic stance and relationship with the patient, rather than prescribing specific required techniques. The burgeoning field also incorporates mainstream psychotherapy practices, like mindfulness-based cognitive therapy or cognitive behavioral therapy, to help patients arrive at their own truths. “The overall goal of Fluence,” Gorman says, “is to make information available to clinicians so they can then adapt it to their own psychotherapeutic orientation.”

For clinicians like Rebecca Kronman, an LCSW who practices in Brooklyn and studied integration with Gorman and Nielson in 2018, the training has been invaluable. She says her practice has exploded since the release of Pollan’s bestseller, estimating that about 50 percent of her patients are seeking guidance to make sense of their psychedelic insights (including challenging emotions that were stirred up by trips, both in the short term or even several months or years later).

But, Kronman points out, it is important for therapists to be tuned in to some key distinctions between mainstream and integration therapy. “It is accessing new research, and accessing spirituality differently,” she says. “It opens up indigenous knowledge and wisdom, and exposes the therapist to things you need to know outside of mainstream therapy, like harm reduction.”

Before creating Fluence, Gorman and Nielson both worked on clinical trials for MDMA and psilocybin, respectively. They also worked as clinicians at the Center for Optimal Living, a New York City-based treatment and training center focusing on Integrative Harm Reduction Therapy—a practice aimed at reducing the negative consequences associated with drug use. “The Center had previously done workshops where they taught integration skills for the public,” Nielson says. “But I really wanted to shift the focus to making the trainings for professionals because I felt that there was a real lack of education for the potential for harm reduction (a set of strategies and ideas intended to reduce negative consequences associated with drug use), and the potential for clinicians to integrate those psychedelic experiences in therapy.”

Gorman and Nielson point to the increasingly popular ketamine treatments as an area where clients are going therapeutically unsupported. Typically, patients who are prescribed ketamine receive a series of infusions over a period of two to six weeks. Gorman and Nielson say that the effects for each person are hard to predict, but could range from dissociative to profoundly psychedelic—even at the standard .5mg/kg dose. Finding a clinician who can help integrate the profundity of the experience, however, is left entirely to the patient.

Nielson notes that most mainstream therapists don’t really know how to have fruitful conversations with patients following their psychedelic experiences, explaining that patients could have heightened anxiety, or attempt to medicate or write off their psychedelic insights as a “drug experience,” which may further pathologize their symptoms. “Patients need to be engaged and involved in their process, and those are the kinds of things we’re teaching therapists,” she adds.

As part of their psychedelic integration training, Fluence’s two-day “general introduction” workshop includes about 10 hours of lectures and four hours of role-playing. "More experienced mental health professionals can participate in a consultation group where they can discuss specific clients and receive support from more experienced clinicians," Gorman said.

Fluence also has a 10-week online course in the works that will feature mock therapy sessions, as well as an advanced class that dives even more deeply into the role of an integration therapist and the issues they may tackle, such as a patient’s desire for ego dissolution.

Fluence also offers continuing education (CE) credits that every licensed mental health professional must obtain to continue their professional practice, a step that Gorman believes is crucial to legitimizing and professionalizing integration therapy.

According to Gorman and Nielson, there are some tenets that every integration specialist should uphold, such as not administering psychedelics, no “trip sitting,” nor directing patients to underground therapists or legal retreats in countries like Costa Rica or Peru.

Not everyone who trips, however, will end up working with a psychedelic integration therapist—at least, not initially. DoubleBlind co-founder Shelby Hartman spent two years attempting to integrate her psychedelic experiences with a mainstream therapist specializing in cognitive behavioral therapy, before a friend finally referred her to a somatically-trained underground integration therapist. Though she describes the mainstream therapist as very sharp, she says they didn’t make much progress together. “Psychedelics are an incredibly profound part of my journey,” she says. “So, it did feel like there was something always kind of missing.”

With the integration therapist, however, she says that in just one session she had several breakthroughs. “It changed everything when I began working with someone who had personal experience with psychedelics and could help me recall what had happened to me during my trips,” she says. “I’ve been doing psychedelics for 10 years and there was so much from trips, long ago, that I had yet to fully process.”

Fluence trains clinicians (more than 500 so far) to not only help well-functioning patients like Hartman integrate their psychedelic experiences, but also to assess clients for “red flag” behaviors like withdrawal or mood changes, to outline contraindications and high-risk cases for those contemplating psychedelic use, and to clarify the role of the therapist in an individual’s integration psychotherapy process.

Gorman predicts that the growing demand for psychedelic integration therapy will further legitimize psychedelic-assisted therapy more broadly. “If things head in the direction they’re going and psychedelics become prescribable, you’re going to have to train therapists to do psychedelic therapy,” he says. “We are going to need to educate not just the therapists, but also the wider group of psychiatric professionals. It could be a problem if you have psychedelic therapies available, but the larger medical infrastructure isn’t aware.”

Gorman and Nielson reiterate that "psychedelic integration is an inquiry process that allows patients to find their own truths—but working with a trained integration therapist may help guide patients toward making their own meaning."

 
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How to become a psychedelic therapist

by Michelle Janikian | Psychedelics Today | 21 Feb 2020

More people than ever are curious to try psychedelics for mental health and personal growth. But even though “psychedelic-assisted therapy” is going mainstream, the actual substances, like psilocybin, MDMA, LSD, and ayahuasca are still Schedule I substances in the U.S. Yet despite their illegality, doctors and therapists are regularly getting inquiries from their clients about psychedelics for addiction, PTSD, depression, and more. So, what can professionals do to start working with psychedelics – legally?

Path one: Legally facilitating psychedelic journeys

At the moment in the US, the only way for clinicians to legally facilitate psychedelic experiences with MDMA or psilocybin is in a clinical trial (we’ll get to substances like cannabis and ketamine below). These trials are being held at select universities in the US, like Johns Hopkins, NYU, and others. Each substance requires their own training by the different organizations that sponsor these trials. In the case of MDMA, that training is provided by the Multidisciplinary Association for Psychedelic Studies (MAPS), and for psilocybin, it’s provided by either Compass Pathways or the Usona Institute, depending on the trial.

MAPS is currently training physicians (MDs, DOs, psychiatrists, and other “eligible prescribers”) as well as licensed therapists to work on phase 3 clinical trials using MDMA for PTSD and to form therapy pairs to open potential “expanded access” sites in the near future. MAPS training consists of five parts, beginning with an online course, which covers the basics from their treatment manual as well as recent scientific research and study protocols.

For part B, trainees attend a 7-day in-person retreat with “senior MDMA-assisted psychotherapy researchers,” which is often Michael and Annie Mithoefer. “The Mithoefers are really the core people that have been doing this since the beginning,” says Angie Leek, MA, LMFT who completed Parts A and B of the training in 2019.“Even if I never get to do this work – which I hope I do – but even if not, it was phenomenal,” elaborates Leek. “It influenced my clinical work without being able to do the MDMA part, for sure.”

Then, parts C, D, and E become more hands-on and include days of experiential learning with an opportunity to have an MDMA session, a day of role-playing, and then, supervision and evaluation of trainees’ first few sessions.

While getting trained to work with MDMA may seem simple and straightforward, the problem is that the training isn’t free. In fact, it’s out of budget for many, especially on a therapist’s salary. For instance, because Leek doesn’t live near a clinical trial site, she has decided not to complete training until the future of the therapy is more concrete. Until then, she can’t afford to keep paying out of pocket. She tells Psychedelics Today she paid $3,500 for the first two parts of the training, and she was told completing all 5 parts costs $7,000. As of now, MAPS has not announced training costs for 2020. Interested clinicians can apply for MAPS MDMA training here.

To work with psilocybin, professionals are trained by either Compass Pathways or the Usona Institute, however (as far as I can tell) training to work with either of these organizations is not currently open to the public. At the moment, only research professionals at universities hosting this research can currently be trained to work with psilocybin.

It’s also important to note that both MDMA- and psilocybin-assisted therapies are on track to become legal, FDA-approved medications for specific conditions in the near future. The FDA has granted both substances “breakthrough therapy status” which fast-tracks them for approval. According to MAPS’s Director of Communications, Brad Burge, MDMA is expected to be approved for the treatment of PTSD by 2021. Yet, in an email, Burge tells Psychedelics Today that MDMA could become available for expanded access in as soon as a few months.

The expanded access program, also known as “compassionate use”, gives patients with life-threatening conditions the right to obtain and use unapproved drugs and medical devices outside of clinical trials. In early 2019, MAPS applied for expanded access for MDMA to treat PTSD, considering the high risk of suicide those with treatment-resistant PTSD face, and it’s expected to pass in early 2020. Therefore, many trained MDMA-assisted therapists and prescribing physicians could be needed very soon to open expanded access MDMA sites around the US.

Which is why another route many in this field consider is applying to the California Institute for Integral Studies (CIIS) Center for Psychedelic Therapies and Research. This one-year long certificate program is an in-depth study on psychedelic-assisted therapy and research, taught by the leading experts in the field, including Anthony Bossis, Rick Doblin, Charles Grob, and Michael and Annie Mithoefer. The program is only available to licensed professionals, like licensed family therapists, medical doctors, and registered nurses. Plus, acceptance into the program is competitive. According to an email CIIS sent to a recent applicant, they will be accepting a total of 75 students for their class of 2020, meaning one in four applicants will be admitted.

The program is completely accredited and considered the most prestigious training for psychedelic-therapists, yet completing the certificate does not guarantee graduates the ability to work with psychedelic substances or even on clinical trials. After completing the certificate, graduates will still have to undergo training from organizations like MAPS, Usona or Compass, and pay for it themselves.

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Path two: Training in trauma and transpersonal psychology

Before professionals jump right into psychedelic-assisted therapy training, there are a few schools of psychological thought and therapy modalities they can get familiar with that can inform their work with “non-ordinary states of consciousness.”

For instance, although CIIS’s psychedelic therapy program may not be the best fit for everyone right now, two therapists we spoke to for this story received their master’s degrees from the university, and chose it for its focus on transpersonal psychology.

Transpersonal psychology is a school of psychological theory that considers the spiritual and transcendent aspects of life alongside modern psychological thinking, and it has been used by professionals to help folks work through altered states for decades. If you’re interested in learning more, check out the books and articles by Stanislav Grof as well as educational programs at Sofia University and Naropa University.

Another important area to be well versed in professionally before working with psychedelics is trauma. In fact, all the experts we spoke to for this story stressed the importance of training in different trauma modalities, especially somatic practices, as well as understanding and being comfortable with transference and projection. This level of comfort comes from both training in the subject matter and doing your own inner work.

While some of the training programs we’ve listed cover these issues, both Leek and Saj Razvi of Innate Path recommended Peter Levine’s Somatic Experiencing training as an informational and trustworthy source of trauma and somatic therapy work. Other integration coaches and therapists have also recommended the Hakomi Institute, a body-centered, trauma-based psychotherapy method that helps people work with strong emotions through mindfulness and guided meditations.

And of course, many in this field stress the importance of professionals doing their own inner work with psychedelics as an important aspect of training. While this can be contested in the community, it does seem like processing one’s own non-ordinary states of consciousness can help others do the same. For now, MAPS’s MDMA training does include an opportunity for clinicians to receive their own MDMA-assisted therapy session. While the CIIS program does not currently include any medicine work, they do incorporate opportunities for transpersonal breathwork and other drug-free forms of altering consciousness.

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Path three: Psychedelic integration therapy training

Both therapists I spoke with for this piece, Robin Kurland, LMFT and Angie Leek, LMFT, told me they’d be interested in getting trained to facilitate psychedelic-assisted therapy in clinical trials, but haven’t found the whole process to be very accessible, especially considering the uncertainty of this work, it’s just not worth it to shell out over $10k for training. However, they both found a compromise in offering their clients “psychedelic integration therapy.”

Unlike psychedelic-assisted therapy, integration therapists do not provide clients with any type of guided psychedelic trip. They can, however, help interested folks in preparing for and then integrating their psychedelic experiences by discussing what it means to them and how they can use any insights or realizations they had in their everyday lives. It’s a very new thing for licensed therapists to offer even though psychedelic therapists in clinical trials and underground have been providing clients with prep and integration sessions for decades. But with the increased interest in this work and in people trying substances on their own or at retreats abroad for healing, aboveground therapists have begun helping people navigate the sometimes tricky emotions that come before and after these peak experiences.

Training for psychedelic integration is limited but exists and is growing quickly. The organization Fluence, based in New York City, hosts accredited classes for interested clinicians, called “Psychedelics 101 and 102” taught by Elizabeth Nielson, Ph.D. and Ingmar Gorman, Ph.D. In their two-day long workshop, they cover everything doctors didn’t learn in medical school about psychedelics, from past and present research to harm reduction and how to help clients prepare for and integrate their sometimes troubling experiences.

There are also options for life coaches and other interested individuals who are not necessarily licensed doctors and therapists. One popular choice is Being True to You (BTTY), which offers a four month long, psychedelic integration coach training program that’s completely online for $3,500.

Here at Psychedelics Today, our founders Joe Moore and Kyle Buller also host an online course for clinicians, therapists, and coaches looking to expand their knowledge of psychedelic research and provide psychedelic integration to clients. The online course is eight-weeks. The first four weeks cover the basics, including the history of psychedelic research, safety tips like preparation and navigating the space, and an intro to Stanislav Grof’s transpersonal psychology framework. Then in weeks 5 through 8, classes get more specific to clinicians, and cover topics like how to support psychedelic-curious clients, how to help clients integrate their experiences, and how to navigate the legal and ethical considerations.

MAPS is also a source of psychedelic integration education and has provided webinars as well as in-person training sessions in the past. This year, MAPS is planning another webinar series with a session on integration, Burge confirms. “Integration tends to be one of the most popular topics we address in our webinars, conferences, and educational materials,” Burge says.

Despite recent training offerings, many psychedelic integration therapists can still get frustrated by this work, mostly because it has to be substance-free at the moment. Kurland says she mostly worries about people taking mushrooms by themselves in less than ideal situations. “That’s really why I want to hurry and get the ball rolling with the FDA and have that certificate [from CIIS]. I would love to just be able to say, I’m going to sit with you and you’re going to be safe. I’m going to hold space for you and whatever comes up, we’re going to work through it and I’ll be there to hold your hand,” says Kurland.

Path four: Working with legal altered states of consciousness

A new option emerging in this field is working with legal or prescription substances, like cannabis and ketamine. Psychiatrists already have the ability to give ketamine to patients in their offices as an “off-label use” for treatment-resistant depression, PTSD, and other conditions. It’s becoming increasingly popular, with ketamine infusion clinics opening around the US. Naturally, there are a number of ketamine training programs emerging alongside. So many, in fact, that we decided to dedicate a whole future piece on ketamine-therapy training, so keep an eye out.

Then there’s cannabis, which many argue is psychedelic in its own right and is legal in a majority of states for adult or medical use. And there are two programs in Colorado taking advantage of that fact. The first was Medicinal Mindfulness; they offer group psychedelic cannabis ceremonies, 1:1 cannabis therapy sessions, and now, cannabis “trip-sitting” training for any interested party.

There is also Innate Path, who began offering cannabis-assisted therapy to clients in 2018 in a very similar fashion to psychedelic therapy, and are now offering training to professionals. Innate Path co-founder and Director of Education, Saj Razvi tells me his cannabis-assisted therapists don’t actually give clients any weed, the client has to bring their own, which avoids any legal conflicts. This allows providers to practice psychedelic therapy before MDMA or psilocybin pass through the FDA, and if it catches on, has the potential to expand access drastically.

Razvi explains the cannabis-assisted therapy modality he and his co-founders have been developing over the course of several years is very body-focused and influenced by his own work as an MDMA-assisted therapist in MAPS’s phase 2 clinical trials, as well as the work of Peter Levine and Eugene Gendlin, the theorist, and philosopher who inspired Levine. At Innate Path’s training workshops, they teach therapists their somatic method, transference work, and psychedelic-therapy principals, which they use for both ketamine and cannabis-assisted therapy.

Of course, there is also the option of working with non-substance induced altered states of consciousness. “Holotropic” or “transpersonal” breathwork is a non-ordinary state very similar or indistinguishable from the psychedelic experience for many. Developed by Stanislav and Christina Grof, they have their own training program called Grof Transpersonal Training (GTT) that teaches practitioners to facilitate and process breathwork experiences with clients.

Dreamshadow Holotropic Breathwork is another group of trustworthy breathwork facilitators who offer an educational training program. Their founders, Lenny and Elizabeth Gibson, are colleagues and close friends of the Grof’s and are also who trained Psychedelics Today founders, Joe Moore and Kyle Buller, in this work.

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Path five: Trip sitting

For clinicians and non-professional folk alike, getting trained to trip sit by MAPS’s Zendo Project is a great entry into the world of psychedelics. Zendo sets up shop at music festivals like Burning Man to provide a safe and tranquil place for people going through difficult psychedelic experiences to come and relax. They train sitters to be a calm and supportive presence for trippers without “guiding” their experience in any direction.

Zendo hosts trip sitting training workshops around the US to prepare interested participants for volunteering at events, and is a great way to learn the basics of “holding space” and to get experience working with those under the influence of a psychedelic substance. Zendo also has great resources for interested folk, like webinars and their book, The Manual of Psychedelic Support.

All in all, there are many options for all skill sets and types of professionals to get involved in this work. While becoming a psychedelic therapist right now might be expensive, it is possible. For those who can’t budget the risk until this therapy becomes more available, there are plenty of other options with lower price tags. We hope this piece cleared up some misconceptions in the community and can help folks choose the right path for them.

We realize there are also underground training options but they can be unreliable and hard to vet, so we decided to only focus on aboveground options for this piece.

 
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MDMA and Psilocybin courses now Live!

Alli Feduccia, PhD | Psychedelic.Support | 28 Jul 2020

We are delighted to announce the launch of our Psychedelic.Support Education Program. Our expansion into education is born from our mission to support individual and global healing and transformation through sharing of knowledge and connection to resources; this effort is also a recognition that trustworthy, scientific, and high-quality education is urgently needed to maximize healing and minimize risk.

To answer the call we've worked with professional and academic leaders in the field and poured our collective years of expertise into the lessons so that you can:

- Learn Anytime, Anywhere: Our self-paced courses in virtual classrooms allow for an interactive experience with other learners and instructors.

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Additionally, you will support our work at Psychedelic.Support. We've run this site as a passion project for the last 2.5 years. Together, with you, we have helped connect many individuals with specialized care. We are affirming our commitment to you and our growing community by offering evidence-based education and practical information. Check our Free introductory course Exploring Psychedelics: Discovery, Research, & Effects.

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Alli Feduccia, PhD
Director, Psychedelic.Support

 
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Pacific Psych Centers gears up for new psychedelic treatments

Psilocybin alpha | Pacific Psych Centers | 24 Jul 2020

As psychedelic medicines emerge as alternatives to conventional mental health therapies, we’re increasingly interested in how they will be administered on a practical level.

We spoke to Jake Hollingsworth, DO, owner and operator of Pacific Psych Centers, a medical clinic that offers—among other treatments—IV ketamine infusions and Spravato (esketamine) for depression. We were particularly interested in how the Center’s clients have received these existing ketamine-based therapies, and how Jake is preparing to offer additional psychedelic medicines as soon as they become available.

Thanks for taking the time to talk to us. Could you tell us a little about your clinic, especially the ketamine therapies you offer?

My wife, who is a board-certified anesthesiologist, and I (I’m a board-certified psychiatrist) run an outpatient psychiatric clinic in Del Mar, California where we offer several treatment modalities including psychiatric medication management and psychotherapy, as well as providing IV ketamine infusions, intranasal esketamine (Spravato), Transcranial Magnetic Stimulation (TMS), men’s hormone replacement therapy, and injectable nutrients. We primarily treat anxiety and mood disorders, and we accept insurance directly for most of our services, with the exception of IV ketamine which is a self-pay treatment. We officially started our practice in late 2015, and it has evolved into what it is today. In the future we hope to bring in psychedelics as treatments, specifically MDMA and psilocybin assuming they eventually obtain FDA approval.

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Dr. Jessica Hollingsworth and Dr. Jake Hollingsworth, Founders of Pacific Psych Centers

What level of demand have you experienced for IV ketamine and Spravato/S-ketamine?

Demand for both has been high and continues to grow. Spravato, being newer and with a much heavier marketing presence from the pharmaceutical industry, is growing at a much faster rate. The demand for ketamine is still growing, but not at the exponential rate that Spravato’s demand is growing. Most cities are somewhat saturated with “ketamine clinics,” so the demand has dropped nationwide.

And, what’s the general consensus from your clients on those treatments?

More success than not. Treatment-resistant depression, by definition, is tough to treat, so when we have a 50-60% success rate in that population of patients with either ketamine or esketamine: I would say that’s good. The intensity of the effect of IV ketamine infusions is much stronger and more altering than intranasal Spravato, but the outcomes regarding depression treatment are very similar between the two treatments. Both are generally well-tolerated and very safe from what I have observed. Our clinic has much more experience with IV ketamine infusions (around 5,000 treatments today) compared with Spravato treatments, which we have done around 300 over the past year.

Have prospective or current clients enquired about other psychedelic medicines?

There is a lot of “buzz” around the potential for the FDA approval of MDMA and psilocybin, and I hear of some patients that are pursuing it on their own. Some are learning how to procure mushrooms via YouTube, some are travelling to South America for ayhuasca retreats.

How do you think the emergence of psychedelic medicines like MDMA and psilocybin will be different to that of medical marijuana?

The biggest difference between MDMA and psilocybin will be the FDA-approval aspect. Cannabis is not FDA-approved for any medical indications. The other issue is that the evidence and efficacy of MDMA and psilocybin for psychiatric indication is substantial, almost hard to believe actually. If the studies continue to show off-the-charts efficacy and safety, these substances are going to blow cannabis out of the water. The only two FDA-approved medications for PTSD are Paxil and Zoloft, and as a psychiatrist I can say that the efficacy is very limited and even when these two medications are effective, they usually come at the cost of significant advese effects like weight gain, sexual side effects, daytime sedation, etc.

What work are you carrying out to prepare to administer MDMA and psilocybin?

We are looking into the MAPS protocols for use and we plan to attend the MAPS training. We plan to build out an MDMA and/or psilocybin treatment room(s) at our clinic. I am going through all the literature and evidence so that we can utilize these medications as soon as it’s legal to do so. We are in the process of creating content for our website regarding these potential treatments for patient education.

What use cases will MDMA and psilocybin cover that IV ketamine and S-ketamine cannot?

MDMA will likely be FDA-approved for PTSD, IV ketamine is only FDA-approved for use as an anaesthetic (and not for any psychiatric purpose), and S-ketamine is only FDA-approved for Major Depressive Disorder (MDD). Those are very important facts because FDA approval as a medication (regardless of the indication) makes it legal for doctors to prescribe it. What it’s FDA-approved for is important because it affects what the insurance companies will pay for. When patients pay out of pocket (i.e., don’t use insurance to pay for treatment), the indications for prescribing are up to the doctor and patient. For example, IV ketamine is not FDA-approved for any psychiatric indications. Doctors can prescribe it for depression as an “off-label” treatment, but the insurance companies won’t cover it. But there will be a lot of overlap in patients across diagnoses, and some will need to wait until insurance companies roll out protocols and policies to pay for them. In the beginning, the patients who are willing to pay out-of-pocket will be the first to have these treatments (psychedelics). We are still slowly rolling out Spravato treatments for patients (despite the demand) more than a year after FDA-approval because the insurance companies have hardly reimbursed our clinics for the treatments we have done to date. Very frustrating for the clinic and for the patients!

Also, for MDMA and psilocybin to be used, patients must be off most psychiatric medications due to the drug-drug interactions. Some patients won’t be able or willing to do this for various reasons. Ketamine has almost zero significant drug-drug interactions so patients don’t need to change their medication regimens. This is an important issue.

In terms of timelines, when do you envisage being able to administer these medicines and therapies in your clinic?

As soon as possible! Assuming they are FDA-approved and we are able to prescribe them using safe and effective protocols we will start utilizing them as soon as they are available. MDMA may be available in 2021/22 and psilocybin will likely be a few years behind MDMA.

 
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  • Chris Stauffer, MD, Assistant Professor, Oregon Health and Science University
  • Bill Richards, PhD, Psychologist, Johns Hopkins University
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  • Emmanuelle Schindler, MD, PhD, Assistant Professor, Yale University
  • Christopher Nicholas, PhD, Assistant Professor, University of Wisconsin
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  • Katrin Preller, PhD, Neuroscientist, University of Zurich
  • Evan Sola, PsyD, Clinical Psychologist, Sage Integrative Health
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University of Wisconsin

Combining therapy with psilocybin results in large reductions of anxiety and depression

by Beth Ellwood | PsyPost | 18 Jun 2020

A recent meta-analysis published in Psychiatry Research provides tentative support for psilocybin in the treatment of depression and anxiety.

Researchers have made important advancements when it comes to the treatment of depression and anxiety, including both pharmacological and behavioral interventions. Nevertheless, existing treatments often have ill side effects or are ineffective for certain patients, pointing to the need for more treatment options. Study authors Simon Goldberg and his team wanted to investigate one possible new treatment option.

“Researchers have recently resumed investigating psychedelic compounds as a novel treatment approach,” the authors say. “One such substance is psilocybin, a plant alkaloid and 5-HT2A receptor agonist.”

Goldberg and associates conducted the first meta-analysis to examine clinical trials investigating the effects of psilocybin among individuals with heightened anxiety or depression.

The analysis included four studies published between the years 2011-2018 and a total of 117 subjects. Three studies took place in the United States and one in the United Kingdom. The samples had an average of 29 participants, and were largely female (58 percent) and White (86 percent). All participants had clinically relevant anxiety or depression symptoms, or a combination of both.

One trial had a single-group, non-controlled design where all participants were administered a dosage of psilocybin. The three remaining trials employed a random design where roughly half the participants received a psilocybin dose and half received a placebo (the control group). In addition to the drug treatment, all four studies incorporated behavioral interventions and support throughout the trial.

Results of the meta-analysis indicated that participants in all four studies showed large reductions in anxiety and depression after receiving psilocybin dosages. Furthermore, the effects of psilocybin were significant even at the six-month follow-up. For the three double-blind studies comparing placebo and psilocybin conditions, the effects of psilocybin on anxiety and depression were also found.

While the results provide support for psilocybin in the treatment of anxiety and depression, the authors discuss several limitations with the analysis. First, as only four studies were included, the observed effects may not be reliable. Additionally, most studies had a high risk of bias, including detection bias caused by insufficient blinding of participants.

One possible avenue for future research is in the treatment-resistant population. “Additional large-scale studies examining the effects of psilocybin on treatment-resistant depression may be warranted, as only one of the four studies focused on this population,” the authors say.

“Nonetheless,” the researchers conclude, “the current meta-analysis suggests psilocybin in combination with behavioral support may provide a safe and effective treatment option for reducing symptoms of anxiety and depression. This is an area for additional careful, scientific study.”

The study, “The experimental effects of psilocybin on symptoms of anxiety and depression: A meta-analysis,” was authored by Simon Goldberg, Brian Pace, Christopher Nicholas, Charles Raison, and Paul Hutson.

 
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How to Become a Psychedelic Therapist

by Andrew Penn RN, MS, NP | Psychology Today | 1 Nov 2020

With increasing research into psychedelics, therapists want to learn more.

News of the renaissance of psychedelic-assisted therapies seems to be everywhere. From Anderson Cooper on 60 Minutes and Michael Pollan’s bestselling 2018 book, How to Change Your Mind, to the proliferation of online webinars, it seems like everyone in the psychotherapy profession is interested in becoming a psychedelic therapist.

Before we delve into this question of becoming a psychedelic therapist, it’s important to acknowledge that, while the studies of psilocybin for depression and MDMA to assist the treatment of PTSD continue to do very well in clinical trials, they are still not yet FDA approved treatments, and remain Schedule I drugs, which means they are illegal to possess or use outside of these studies. It also means that there is no guarantee that the drugs will get FDA approval, though it is looking increasingly likely that they will become available in the next two to five years.

With this promising treatment on the horizon and growing interest among mental health professionals, it is not surprising that an increasing number of educational providers are creating programs offering “psychedelic therapist training.” I am a graduate of one of these programs, the California Institute of Integral Studies (CIIS) Center for Psychedelic Therapy and Research (2017), and have been fortunate to put my training to work as a therapist on the Phase 3 MAPS sponsored MDMA assisted therapy for PTSD study and will soon begin working on the Phase 2 Usona sponsored psilocybin facilitated therapy for depression study. Some of my classmates have begun ketamine clinics or conducted research in this field, but it’s worth noting that most of my classmates have not begun to provide this therapy in practice and continue to provide conventional psychotherapy or medical treatments of mental illness while we wait for the clinical trials to complete.

An important caveat is needed here: All of the proliferating programs offering training in psychedelic therapy must speculate on what the FDA will require to provide this therapy. Ultimately, the FDA, as part of a REMS (risk evaluation and mitigation strategy) program that will be part of any approval of these medicines will likely require a licensed therapist or medical professional to provide this therapy. Some of these terms, such as it always being a supervised therapy and not a take-home treatment, are easy to predict. Others, such as the qualifications that will be needed to be a psychedelic therapist, remain a work very much in progress.

It is clear that whatever form psychedelic therapy takes, it will only be allowed to be provided by licensed professionals. However, the license that will be required is, as of now, unclear. It is possible that the FDA will only allow a medical doctor or a clinical psychologist to provide this treatment, though the sponsors of the studies are arguing that other providers such as nurses, marriage family therapists, and even clergy could be trained and equally skilled to provide this therapy. Another unclear area is if additional training in psychedelic therapy will be required to provide this treatment, and if so, what that training will be. Given the cost of these programs, the tuition is a somewhat speculative investment in one’s future employment prospects.

That is where these burgeoning training programs enter the picture. While many of them are being offered and taught by pioneers in the field, they are inherently speculating regarding whether their curricula will fulfill the future FDA requirements to deliver these treatments. In this heady time, we are building the plane as we are flying it. It’s with that caveat that I will discuss a handful of these programs (this is not a comprehensive list and will likely soon become even larger as additional programs emerge).

The program I attended, the CIIS Center for Psychedelic Therapies and Research is one of the oldest programs and arguably the progenitor of more recent programs. The CIIS program admitted its first class in 2016 and has now trained over 300 professionals. Directed by Janis Phelps, Ph.D., this program brings together some of the primary researchers in the field from places such as Johns Hopkins, NYU, MAPS, Usona Institute, and Imperial College, London to teach students about psychedelic therapy — as a psychedelics geek, it felt like what it would have been like to be studying humanistic psychology in the 1950s and having Abraham Maslow and Carl Rogers as your professors. This postgraduate program admits licensed professionals and ordained clergy into an 8-month (March-November) program leading to a certificate. It recently divided into a San Francisco cohort and a Boston cohort which will increase their training from 80 professionals to 200. The Boston location also allows for collaboration with the Boston Psychedelic Research Group and the new Center for the Neuroscience of Psychedelics at Massachusetts General Hospital.

Fluence offers a 120-hour certificate in psychedelic integration therapy (this is therapy provided to a client who has already had a psychedelic journey and is trying to integrate what was realized or learned from the experience into their daily lives), that like CIIS, is restricted to licensed therapists. Fluence was founded by several veterans of MDMA-assisted therapy studies and by a co-principal investigator of the landmark Psilocybin Cancer Anxiety study at NYU.

MAPS, which is the sponsor of MDMA assisted psychotherapy studies for PTSD, formed MAPS Public Benefit Corporation as a wholly-owned subsidiary to shepherd MDMA through FDA approval and offer training to therapists who are interested in providing this treatment. Other study sponsors, such as Usona Institute and Compass Pathways (studying psilocybin facilitated therapy for depression) have therapist training programs for clinicians working in their studies and may extend these training opportunities to others in the future.

It is important to note that a significant challenge of these educational programs is the inability to provide students with a direct experience of either providing the therapy (as research studies typically do not have the ability to host observers and students) or receiving the therapeutic drugs themselves (because of controlled substance restriction). Many programs use holotropic breathwork as an experiential means of allowing students to experience a non-ordinary state without a drug.

For those therapists who are not yet ready to undertake a formal training program, it is advised that you become familiar with this emerging treatment through reading (this book by Francoise Bourzat and this by Bill Richards are good places to start). This podcast interview from MAPS therapist Marcela Ot’alora G is especially good) and attending the briefer conferences that are increasingly on offer. Additionally, learning to work with non-ordinary states of consciousness through programs such as Hakomi, Somatic Experiencing, or the aforementioned holotropic breathwork, are useful modalities for future psychedelic therapists.

As mentioned, this is far from a comprehensive list of resources. The professional organization I helped to found, the Organization for Psychedelic and Entheogenic Nurses maintains a growing list of these programs on our webpage and I have discussed other ways of getting experience with psychedelic states here.

Regardless of how the psychedelic training bonanza shakes out, this is an exciting time to be in the field, as we watch the dawn of a new era, with the attendant hope that it brings, breaks across the landscape of our profession. Those who are motivated to learn how to better help our patients can only find reward in this exciting new field.

To find a therapist, please visit the Psychology Today Therapy Directory.

 
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How To Provide Psychedelic Support

by Adam Rubin | LUCID | 5 Dec 2020

The world is in crisis. The pandemic has impacted every human on this planet in a deeply personal way. It is only natural for people to seek ways to feel lighter. Many of us are looking for relief from the fear and isolation sparked by COVID-19, reaching to experience pleasure and connection during this time of intense disconnection.

Some people seek to optimize and comfort themselves through psychedelic compounds. Psychedelics have been used throughout history for celebration, recreation, inner exploration and spiritual evolution. Widely circulated studies have shown the mental health benefits of psychedelic-assisted therapies. It’s not surprising that people are choosing to increasingly use these substances in non-medical and social settings during a time of hardship.

Those who use psychedelics sometimes have challenging experiences when they shift their consciousness. Creating support systems for different kinds of encounters with psychedelics help people receive appropriate care and avoid unnecessary encounters with law enforcement or emergency services.

The following are some key points for providing psychedelic support in different situations including by telephone, video call, encounters within your COVID-19 pod and outside your COVID-19 pod.

Much of the information, strategies, and techniques presented here are drawn from personal and professional research and direct experience. I work full time as a crisis counselor for a phone hotline service. I provide in-person psychedelic risk reduction at festivals and gatherings and I manage online psychedelic peer support at virtual events. These are pro tips that you can use in any situation, anywhere, in any setting.


The Basics of psychedelic support
  • Remain Grounded and Centered. There is no rush to do something or get anywhere.
  • Assess for Safety. Is the voyager in imminent danger to self or others? Are they medically stable? If the situation is unsafe, work towards finding safety and/or escalate to emergency services.
  • Once safety is established, connect with the voyager by listening (without judgment) to what they are experiencing. Validate and reflect emotions that arise throughout the conversation. “It sounds really intense right now, you feel afraid and confused.”
  • If possible, find out what substance they took and when. This will help you assess potential medical needs and expected duration of the experience. Reassure the voyager that this too shall pass and that they will return to their baseline state of consciousness in a few hours.
  • Explore the voyager’s setting with them. Setting can greatly influence the experience. Is the voyager in a loud, stimulating environment? See if they can go somewhere quieter or calmer.
  • Stay present and grounded and let the voyager drive the process. Invite them to relax into the experience. Remind them that they are safe and you are with them. Encourage deep breaths and hydration. Focus awareness on breathing and physical alignment.
  • All emotions are welcome here. Avoid trying to get someone to feel “better.” Healing can be hard and that’s okay.
  • Allow for moments of silence. This could be a sign that the voyager is going inward. “We don’t need to talk a lot right now. I’ll stay on the phone/zoom/etc. with you and if you need to check in, I’ll be here.”
  • Practice thoughtful Self-Care and make sure your own basic needs are being met.

Over the phone

Suppose your friend is in pandemic lockdown and hasn’t been able to see you or your other friends in a while. They decide to take a solo trip on their own, thinking they might do a small dose and enjoy some music in their isolation. Suddenly they realize that they may have taken more than they expected and need a familiar face, or voice. They call you in distress.
  • Your primary tool is verbal connection and conversation.
  • Key words to help guide and support the person’s engagement: Remain Grounded, Curiosity, Validation, Empathy, Reflection, Allowing, Trusting, Slowing Down
  • Use your voice to create a connection to your grounded presence. Remember to allow for silence too.
  • Example phrases:
    • “Can you describe what you are experiencing right now?”
    • “How does that feel in your body?”
    • “It’s really intense right now. I’m right here with you. This will pass.”
    • “Are you open to taking a few deep breaths right now?”
    • “Clarity will likely come later on. This experience is welcome here.”
    • Caller: “I feel like I need to sing…” Support: “Go ahead and sing!”

On Zoom/video call

Similar to a situation that involves a phone call, some voyagers may prefer a video call. This is common at online events where virtual risk reduction teams assist altered participants in a dedicated Zoom Room or other digital space.
  • Consider creating a visual environment that is calming, an atmosphere with warm lighting and beautiful backgrounds (perhaps a single tapestry) rather than a blank wall, overstimulating or messy spaces.
  • Be aware of your body language and positioning towards the camera. Look at the difference between shoulders square with the camera versus slightly turned.
  • Allow the voyager to disengage from the screen when they feel ready. Screens are stimulating on their own.

Inside your pod

This is likely the safest possible way to be a support person for psychedelic experiences. When the voyager and the support person are already within the same level of exposure or non-exposure to one another, they can have a more direct encounter. This is usually reserved for close friends, family, or housemates.
  • If the voyager and support person are members of the same COVID-19 pod, this means they share common agreements and care around COVID-19 safety outside the pod. People within the pod are likely in close proximity and unmasked around one another in their daily lives.
  • Because the pod is already in close connection, there are no extra considerations to address around COVID-19 safety.
  • The advantage to this situation is that support can be offered in person and in close range, even inviting nurturing touch like holding hands or hugging.

Outside your pod

This situation goes straight to the heart of risk reduction. We need to be honest with ourselves about what is going on around us if we are going to find ways to make the situation safer.

Despite the risks of spreading COVID-19, people are still gathering. Each of these gatherings have their own threshold for COVID-19 safety practices. This ranges from all participants being tested before attendance, to completely ignoring COVID-19 as a reality. For those of you attending and providing peer support at potentially high-risk gatherings, please carefully consider the following:
  • If the voyager and support person are not part of the same pod, COVID-19 risks are much higher and require special attention.
  • Once safety and connection is established between the voyager and support person, the support person should attempt to clearly and compassionately state COVID-19. boundaries such as: “I’m right here with you and I’m going to keep my mask on and remain at least 6 feet from you.”
  • If there are soft objects nearby, such as a pillow or blanket, offer those items to the voyager as a stand in for physical contact if they really want someone closer to them.
  • COVID-19 is primarily transferred through respiratory droplets (via coughing, sneezing, or talking closely to one another). If the voyager is unmasked, keep in mind that distance and positioning is important to help protect your own safety. Encourage them to put on a mask.

Setting considerations

  • Indoors: Can feel like a more held/contained/controlled environment for the voyager’s experience. However sharing indoor space presents a higher risk for COVID-19 exposure.
  • Outdoors: Voyager may feel more exposed or not warm enough. Possibility of COVID-19 transmission is reduced in this lower risk environment.
  • Outdoor Space with Tapestries/Privacy Walls: Most ideal set up.
  • Personal Protective Equipment (PPE): Have masks, gloves, visor/goggles, hand sanitizer and disinfectant wipes available for yourself and the voyager at all times. A person deep into a psychedelic experience may not be able to comply with COVID-19 safety protocols or may reject these suggestions.
Throughout the process of providing psychedelic support to people outside your pod, you will need to be ready to disinfect nearby objects, surfaces and yourself. At regular intervals, change and wash the clothes worn while providing supportive care. Wash your hands frequently and take a shower when you return home. Disinfect your phone and other objects in your possession. Wipe down your car and high touch surfaces.

People have an inherent need for joy, connection, creativity, and self-understanding, especially in dark and isolating times such as these. This information is meant to provide some insight and preparation for those who serve as a lighthouse for their fellow voyagers in the stormy seas of this pandemic.

 
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Keys for integrating psychedelic experiences

by Denis Dubouchet & Rosine Fiévet | Psychedelics Today | 16 Nov 2020

Working in psychotherapy with substances such as LSD, MDMA, and psilocybin in order to help heal depression, post-traumatic stress, or to overcome death anxiety has been the subject of many publications. Some authors, such as Stanislav Grof, have even gone so far as to establish new stages in human development. Just as Freud in his time conceived of psychopathology on the basis of trauma in the oral, anal, or genital stages, Grof postulates that certain behavioral disorders stem from suffering encountered in one of the four perinatal stages. In conjunction, both older (James Fadiman, Michael Mithoefer) and more recent authors (Benny Shannon, Eric Vermetten) have modeled psychotherapy settings that use work under psychedelic substance.

Our aim today is not to question these different approaches and their possible transferability to countries where the law prohibits such practices. Indeed, what are the implications regarding the relationship with therapists when working in a framework outside the law, which imposes secrecy towards the environment? What does this induce in therapy?

In France, the law prohibits the use of substances in psychotherapy. However, in our therapists’ offices, we receive people who have gone abroad to other continents to have psychedelic experiences (whether conducted according to traditional practices or not) or even to nearby countries where foreign shamans come to perform ceremonies. The people who come to consult in this context have either had a “bad trip” that still disturbs them, or are no longer able to reintegrate socially after a strong mystical experience, or, still further, want to understand and integrate what they have lived through.

This is “afterthought” process work that differs from what a therapeutic framework would have involved, with preparation prior to the experience, specific therapeutic support during the experience, and an integration (the phase where meaning is given, where the experience is symbolized) and assimilation (the phase when we are able to link this experience to all our past experiences and our history, enabling us to visit prior beliefs) of the elements that emerged during the experience. Indeed, the psychedelic experience induces a shock by opening up hitherto unknown spaces which the psyche does not know what to do with, or, if it does, it will literally cling to the visions that have arisen during the experience, even if this means being out of step with daily reality.

These people come knocking at our door because they know that in addition to our training as a psychologist and psychotherapist, we have been initiated into shamanic practices. As such, we are supposed to know all about this, or, at least, are willing to hear non-ordinary stories without limiting our diagnosis to psychopathology. Through this approach, we are asked to hear these accounts not as pure madness, but to take care of their experience as a salient moment in their lives, even if a painful one.

In doing so, the experiencers come to challenge our own reference grids and our anthropology. Applying a single theoretical reference frame as we usually do in therapy has the risk of greatly reducing our understanding of the experience, even if this frame of reference was based on the transpersonal current. From our point of view, Grof’s perinatal stages or the archetypes of Carl Jung or Gilbert Durand cannot, by themselves, sufficiently support the elaboration work required by our patients. We believe that elements emerging during a psychedelic experiment are polysemic. They must be looked at on several levels: symbolic, metaphorical, transcendental, processual, as well as on the ego and somatic levels. Each level can, in itself, feature several interpretations.

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For example, if I see myself as a warrior killing the dragon to free the princess:

-This may symbolize a problem in my married life which is very difficult to solve (we talk about symbolism at this point, because in our culture, references to the warrior and the princess speak of couples, as seen in children’s tales).

-At the level of the ego, it may question my desire to be recognized by my wife, or manifest my need to be seen as a powerful man.
-At the transcendental level, I may be envisaging the influence of superior, and even very ancient archetypal forces impacting my life as a couple.
-On a metaphorical level, it could be interpreted as the work I have to do to channel masculine strength and liberate the feminine dimension of my being.
-On the somatic level, during this experience, I may have felt a lot of energy inside, which could point towards the fact that I have a lot of inner energy at my disposal to obtain what I desire.
-On a process level, if I follow through with my vision, it has me view my wife as a weak person in need of rescue. Maybe this reveals my thoughts on male/female relationships.
-And at the transgenerational level, it may evoke how one of my ancestors forced a marriage upon his family against their advice.

The symbolic and metaphorical levels can overlap, and it’s often a very fine line to distinguish between them, and not necessarily always useful to do so. However, it is essential for therapists to keep these different levels in mind so that interpretations can be broken down and not rushed through too quickly, for the sake of an immediate ‘aha’ moment that would obscure and eliminate all other possibilities.

At the same time, a single level of interpretation may contain several meanings. For example, at the symbolic level, seeing oneself locked in a dark cave from which no escape is possible can represent how my current life is functioning now, just as it can symbolize the overwhelming constraints which I am confronted with in my environment, or my inability to see my situation clearly, etc.


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To shed light on our way of working, we offer below three very different clinical cases.

Marc is a 38-year-old man. He lives alone without any children. His mother died when he was 20, and he sees his father quite regularly. He has little contact with his brother, who lives far away. Marc has been to South America, where he tried mushrooms, peyote, and ayahuasca. During his experiences, he was given a highly spiritual task: to attain spiritual enlightenment and guide his fellow citizens on this path. He saw himself as having high spiritual potential and became convinced that this was his destiny. Unfortunately, his return home to France was not as smooth as expected. There were no followers to be found. His speeches were met with irony. He didn’t make a good Messiah. Disheartened and still convinced by the visions he experienced deep inside, he isolated himself and drifted into a state of depression.

When we meet him for the first time and ask him about the faith he has in his own visions, he answers that his mother had the gift of clairvoyance and that she spoke “The language,” implying the language used by Christ. So there was no doubt that he had to continue the work of his lineage, being himself, like his mother, a person different from others.

From a psychological viewpoint, we could make the hypothesis of narcissistic disorder, eased by an extraordinary ideal. This defense mechanism against narcissistic collapse, however, is undermined by the lack of disciples. The depressive movement is the reason for his consulting us, and not his psychedelic experiences, which he believes to have understood sufficiently well.

Initially, no attempt was made to deconstruct his defense mechanism. We looked at his mission and more precisely how he had come to this conclusion. Based on his visions where he had sensed divine power within and where he had seen himself conveying it to others, we came up with several other interpretations for each of the levels previously evoked.

For example, divine power was seen as a spark of life shared by every human being (transcendental level). It was no longer a superpower that he possessed and that made him into an exceptional being. Together, we worked on his representation of the visible and invisible worlds, and the beliefs attached to these representations; namely, whether every human being had a mission, who assigned it, and whether we all had some degree of freedom with regard to this mission.

We also looked to see if this mission could stand as a metaphor for the way his family functioned, in which one person was the leader of all. We explored his family lineages. Was this “gift” already present over several generations? He thought his maternal grandmother had it, but wasn’t sure. He could only confirm that this particular trait was not recognized by those around him. Rather, it caused exclusion. This was a form of transgenerational recurrence. He thus was able to see exclusion as something to be avoided and discontinued. We did not go any further on that level.

Next, we addressed the level of ego, in this case, the desire to be recognized, admired, loved, and to be able to guide others. Through this inquiry, he was able to let go of his feeling of being all-powerful. It reintroduced a notion of intersubjectivity that he was overriding. It was also a way of looking at his limits and of accepting his shortcomings, thus allowing acceptance of a sufficient level of frustration (in the psychoanalytical sense) to live in society.

We suggested to him to let his vision unfold to the maximum (on the imaginary level), push it to the limit, and see how that would be for him, and what he would learn from it. This is the process level. When we go to the very end of the rationale of “I have something divine that I must share with others,” it most often leads to a crazy, untenable position. In this situation, it could well lead to becoming a new Christ. Pushed to this extreme, he felt that it was not right.

During these experiences, he had felt full of energy. He told himself that it would be forever present in him and that he could rely on it for his new life projects. Working on the different interpretation levels allowed him to let go of the initial conclusion that had stuck him in an unbearable pattern. Working on his ego, he resumed humility, which, in turn, helped him find a job in nature that he easily adapted to.

Exploring the transcendental level through how he viewed the visible and invisible worlds set him back on a spiritual path that did not split him off from the people he knew. In this case, we can speak of a shock or intrusion that caused spiritual trauma. If psychedelics have been shown to open up a spiritual space that is helpful for the person, they can just as easily cause a form of trauma, because the experience cannot be integrated, thus locking the individual into an alienating dynamic.

This example shows us once again the regrettable absence of a containing setting when using psychedelics. Such experiments proposed in a different cultural context, with codes often unknown to us Westerners, do not allow the experimenters to integrate the contents of their experience.

The second situation refers to a person who underwent a bad experience using psychedelics with a sitter in a supposedly therapeutic context.

Simon had taken LSD. After marveling at the fantastic images and colorful music, he had found himself locked in a kind of hell with viscous, crooked, suffering beings. Some of them were obsessed with sex. Disgusted, Simon could see in these beings all the darkness of their souls. A voice sounded in his ears: “You’re just like them, just as bad… You’ll never get away with it… You’re doomed to stay here…”

In fact, until the end of his psychedelic experience, Simon would not leave this space. Very affected and upset by his experience, he shared it with his sitter, whose answer was: “The medicine knows what is good for you… Let this experience take you through.”

A state of depression ensued. Simon couldn’t bear to see this hideous evil forever lodged in the depths of his soul. He saw no way out of this condemnation. The darkness of the images he had seen on that trip had left a deep impression on him. He imagined he’d be stuck there even after his death. This state lasted more than three months without his sitter being able to help him any further. She was always evasive during their phone calls, probably overwhelmed by the situation herself.

It was at this point that Simon began work to heal his depression. We invited him to delve into the darkness he evoked and see how it was inscribed within. Through our elaborations, differentiation was made between his cowardice in everyday life, the fears that triggered aggression, the frustrations generating anger, and the possessive, predatory nature of his sex drive.

The darkness he witnessed during the journey was no longer a shapeless, slimy magma. In fact, each element of this hell could metaphorically represent an aspect of Simon’s personality. Viewed in this way, it provided a perspective to work with. By unfolding each element, we were able to extract him from the suffocating magma he couldn’t shake free from before.

This “bad trip” can be construed as an attack on the ego. The ego seeing itself in its darkest aspects with no hope of breaking out triggered the depressive episode. The attack on the ego also contributed to taking a good look at the reverse polarity: “Who do you think you are, to imagine you’d be free from negativity?” The process allowed Simon to identify his quest for an idealized self (being a good person in all respects), which cut him off from a whole part of his being.

His spiritual quest, as he practiced it, let him off from confronting his shadow areas. In fact, it really supported a cheap narcissism. However, it was actually through this soul-searching initiative that he finally was able to take into account the shadows perceived during his journey. He saw them as constitutive of all human beings, i.e. elements that everyone had to work on.

This transcendental perspective made him accept his shadow areas and brought him out of his self-condemnation that had frozen his being. Having to improve on these negative areas, as with any human being, brought movement back into his life. It also gave him more compassion for others and for their shortcomings.

At the process level, this experience was analyzed on two levels:

-The form of idealization that he held for his sitter was shattered. Through this idealization, Simon was looking for a knowledgeable figure who would pass on their knowledge to him. From the pupil being taught special knowledge, he became the grown man making the effort to search for himself. The fact that the sitter had failed to be of help forced him to give up his search for a master and to discover himself.
-The second level of the process consisted of pursuing his vision to the end, i.e. remaining locked up in this hell. Simon then asked himself who held such a power to condemn? Could God condemn a human being to such a degree?

Several hypotheses were offered to Simon on the basis of his spiritual beliefs:

-Christ (Simon had been raised as a Catholic) is a God of love and forgiveness. This is what He preaches. Simon could not see Him condemn in this way.
-Reincarnation makes us consider death a passage and not a prison.
-Returning to the original source is not what he had seen either.

Simon concluded that the only one who could condemn him to this hell was himself. He had to learn to forgive and have compassion for himself, which was quite different from a narcissistic drive.

At the same time, he had also associated the image of hell with what his father had endured during the war. This episode was never talked about in the family, and, as Simon saw it, everything about that war was censored in his family. Through his vision, it was as if that hushed-up part of family history was finally revealed. That’s how Simon interpreted it. Without talking about closer ties between father and son, Simon understood and accepted more of his father’s silence. It also opened up a whole new set of questions about his transgenerational legacies.

Working this way on the different levels enabled Simon to move out of his depressive state. This example shows that the medicine does not do the work on its own, contrary to what is sometimes claimed by some counselors. The qualification of the counselor/sitter is fundamental.

The third example tells us about a defaulting set and setting.

Elizabeth had been experimenting with a friend, Birgit. One day, Birgit suggested she should work with an LSD specialist she knew and admired highly. Elizabeth agreed, but some time before the experience, she got into an argument with Birgit.

On the day of her experience, Elizabeth was greeted very coldly by her friend, who quickly introduced her to the specialist before she left. After taking LSD, Elizabeth was shown into a small room, with a stained bed and deafening music. She remarked on the lack of cleanliness of the sheets, but at the insistence of the sitter, she moved in with resignation and disgust. After some time, Elizabeth got up and asked to move to a chair in another room. A power struggle immediately ensued. The sitter refused and, in a rage, Elizabeth physically grabbed her. Frightened, the sitter gave in. Shortly thereafter, Birgit reappeared. Elizabeth was beginning to come to her senses. Confused by the tense atmosphere, she decided to go home against Birgit’s advice.

This experience left Elizabeth in a deep state of unease and she severed contact with both her friend and the sitter. She thought things over without really understanding what had happened. Guilt took over.

A few months later, she signed up for a trip to swim with dolphins. Two striking events followed: a mother dolphin and her baby dolphin came to swim with her. Then, a hummingbird landed on her while she was lying on the sailboat in the open sea. These two events caused a shockwave. The discomfort disappeared and gave way to an old childhood memory of being in communion with animals. She had rediscovered the simple joy and wonder of her childhood nature.

Looking back with Elizabeth on what had happened, she saw these moments as signs of healing that her soul had granted her- an interpretation based on her spiritual approach strongly anchored in shamanism. This interpretation, based on a transcendental perspective, but also on a childhood experience, had reconciled her with life through connection to the animal world.

Yet there were further developments to the session. Her relationship with her friend Birgit changed. From a relationship of dependence, she went through a period of anger, sadness, and then detachment. She came to see how the emotional bond was tied in with a form of submission. This issue, playing out on the level of the ego, concerned all three persons involved. Each one was playing their part in the game (loyalty, displacement of the bond, and roles).

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How the framework is set and how the setting (physical conditions) is organized will have a strong impact on the experience, since it conditions mindset and the inner security with which the experience is met: many psychic contents will be colored by those factors. It also underlines the importance of the sitters/caretakers overcoming personal issues in order to avoid feeding them back unconsciously into their work environment.

Thus the framework, which had become violent due to the climate of disagreement (above and beyond the mere dirtiness of the sheets and the intensity of the music), had, in turn, summoned Elizabeth’s physical violence. Realizing how everyone had participated in the unfolding of this session, Elizabeth was able to refrain from taking on all the guilt and to see what recurring patterns were at play in her relationships.

Curiously, Elizabeth had few memories of what she saw during her trip, other than her strong desire to admire the beauty of spring outside, from the vantage of a clean and quiet environment. It was as if the most important part of the experience revolved around what happened between these three people. In this situation, the process level stood out clearly. This episode also echoed on the metaphorical level for Elizabeth. It highlighted how the people who needed to take care of her had failed to do so, and how nature had made up for it.

The multiple levels summoned in the integration work (and their scope) require of the therapist a real freedom and skill in wielding the whole keyboard of interpretive planes, i.e. a vast opening to numerous therapeutic, symbolic, emotional, processual, transgenerational, and spiritual meanings, in the face of the infinite psychic contents unveiled in these experiences.




Through these three clinical vignettes, we propose a structured intervention framework quite different from what is applied in traditional therapies, and that we use when assisting clients with such painful experiences or “bad trips.” We insist on the polysemic nature of each vision and on the different levels to be explored:

-The symbolic level
-The level of ego
-The transcendental level
-The somatic level
-The process level
-The transgenerational level

Of course, when exploring all these levels, some may not be relevant to the person’s experience. Yet we ought not be satisfied with the first insight singled out, which would lead to an overlooking of the other equally relevant possibilities. We have often noticed that by focusing on a first interpretation, one failed to question the ego level, thus avoiding an awkward challenge.

In fact, this type of work unfolds in time. Integration and assimilation cannot happen in the span of a few rare sessions following the stressful experience. Indeed, these bad experiences often confront our clients with hidden elements of their functioning, beliefs, or history, i.e. elements which they were not ready to face, hence the importance of in-depth support.

 
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