Therapy

Today, there are few places in the United States where it is legal to access psychedelic-assisted therapy outside of clinical trials. But this is starting to change. Ketamine clinics are legal, and, in 2020, Oregon became the first state to legalize supervised psilocybin treatment. Oregon will start accepting applications for psilocybin treatment licenses in 2023, assuming the federal government doesn’t stop it. Several other states may soon follow Oregon’s lead. Regardless of whether psychedelic-assisted therapy is legalized, safety is still an important concern, and patients need to find the right space and therapist for them.

Set and Setting

While there is a growing body of evidence that psychedelic-assisted therapy can help alleviate depression, anxiety, substance-use disorders, and PTSD, people respond to psychedelics differently. Researchers are trying to better understand how and why people are affected in varying ways, and why people may react differently each time they take a psychedelic. Set and setting are two variables that can hugely affect a psychedelic experience. The “set” is internal: the mental state, or the thoughts, experiences, emotions, expectations, and life history that one brings into a psychedelic experience. The “setting” is external: the physical and social environment in which the experience takes place, such as in a forest, in a doctor’s office, or with a trusted friend at home. 

Click here to learn more about set and setting.

Best Practices and Consent

As with any therapy, in the case of a therapist working with psychedelics, it’s important for the client to feel safe and supported. The American Psychedelic Practitioners Association, or APPA, is a group of psychedelic therapists, guides, and researchers working to establish professional guidelines and accreditation standards for psychedelic therapists.

BCSP spoke with Megan Frost, a physician and chair of the APPA ethics committee, about best practices around communication and consent for psychedelic facilitation.


BCSP

“How can someone find the right psychedelic therapist and avoid the wrong one?

Megan Frost

“Just like with any type of health-care provider, meeting with them initially is an important step to evaluate your own level of comfort. That first conversation doesn’t commit you to working with them. You should feel comfortable with the provider and they should take adequate time to answer your questions, assess whether you would benefit from working with them, and then prepare you for the experience. You should not feel rushed or pressured. If you have any concerns about working with that provider, you should feel comfortable either discussing those concerns with them or finding another provider.”

“The use of touch is always voluntary and completely up to the client.”


BCSP

What questions should someone ask a potential therapist or guide about touch?

Megan Frost

Providers should have their own protocols regarding touch and be able to describe them to you. Regardless of their protocol, the use of touch is always voluntary and completely up to the client. There should never be any sexual touch between a provider and their client. There are types of somatic therapy where a provider is trained in specific kinds of therapeutic touch, and it’s reasonable to ask your provider whether they have training in these areas and what purpose the touch is meant to provide. Regardless of their training, the client should ultimately draw the line about their consent to touch.


BCSP

How should someone navigate consent with a guide about touch while on psychedelics?

Megan Frost

“Again, providers should have their own protocols regarding informed consent and touch, and they should cover it in detail while they’re preparing you for the experience. During the experience, if the client decides they no longer want touch that had previously been agreed upon, then the provider should cease all touch immediately. There are differing opinions on how providers should handle touch when it was initially declined in a preparation session and then asked for during a medicine session, so it’s reasonable to discuss this potential scenario with your provider during the preparation session and agree upon a comfortable solution for yourself.”

This interview was edited for length and clarity.

Finding Psychedelic Therapy Support

Due to current U.S. federal law, there is currently no easy way to find a qualified psychedelic therapist or guide who can be with you during a psychedelic experience. It may be easier to find therapists who can help you integrate a psychedelic experience afterward. For preparation, facilitated drug sessions, and integration, some people turn to underground guides. Others travel to countries like Brazil, Jamaica, or the Netherlands, where some psychedelics are legal. However, psychedelic tourism can harm Indigenous traditions, and there have been reports of misconduct in clinical trials, in the psychedelic underground, and at legal retreats abroad, although some legal retreats abroad have well-developed ethical standards.

The KRIYA Institute and Ketamine Psychotherapy Associates provide directories of therapists who offer ketamine treatment. There are also several online directories of practitioners who can help with integration more broadly, including MAPS and Psychedelic Support, but the providers have not been vetted. BCSP doesn’t endorse any specific providers.

Code of Conduct

In response to reports of misconduct and sexual assault during psychedelic sessions, research organizations have created several sets of professional guidelines for psychedelic practitioners and people participating in clinical trials.

A brief Code of Ethics for Spiritual Guides was first published in 1995 by the Council on Spiritual Practices, intended as a model for guidelines and standards of the profession. It has led to other codes, such as one from the MAPS, the Multidisciplinary Association for Psychedelic Studies. MAPS has also produced a treatment manual for conducting MDMA-assisted therapy to treat PTSD.

Therapist Training

There are a growing number of training programs for therapists, psychologists, and psychiatrists looking to integrate psychedelic treatment into their practice. 

Some for-profit companies advertise training programs, as do some organizations, including MAPS, the California Institute of Integral Studies, Fluence, COMPASS Pathways, Synthesis, and Naropa University. New York University, Yale University, and Johns Hopkins University are jointly developing a program as well. 

Beginning in September 2022, BCSP will launch its own Certificate Program in Psychedelic Facilitation, designed for advanced religious, spiritual-care, and health-care professionals working in areas such as chaplaincy, ministry, medicine, nursing, mental-health counseling, psychiatry, and social work. To learn more click here.

Oregon Psilocybin Services

In Oregon, voters approved a 2020 ballot measure that legalized guided psilocybin sessions in the state. (They remain illegal federally.) Oregon Psilocybin Services will regulate everything from the production of the psilocybe mushrooms to the training providers must have to legally practice in the state. Currently, Oregon is drafting a number of documents related to the ballot measure, including a code of conduct for providers and an approval process for training programs. The state will begin issuing licenses in 2023.

For more detailed and up-to-date information about how Oregon is navigating legalization, check out The Microdose.