What you need to know
As public interest grows in the potential for psychedelic substances to treat mental illness and addictions, it is becoming more important for service providers to become educated about how to support clients interested in psychedelic use. In this peer-reviewed article, the researchers highlight the promise of harm reduction and integration therapy (HRIT) and discuss legal and ethical considerations, along with ways to lessen risks to both clients and clinicians engaging with the topic of psychedelics.
Background
In clinical research trials, psychedelic substances are increasingly being shown to have therapeutic benefits for people with mental health or substance use concerns. These include lysergic acid diethylamide (LSD), mescaline, dimethyltryptamine (DMT) and psilocybin. As a result, the number of people seeking psychedelic-assisted therapy is also increasing, making it more important that service providers become educated about psychedelics. In most jurisdictions, psychedelics remain controlled substances. Therefore, there are a number of legal and ethical factors that service providers must consider as they support clients interested in psychedelic experiences.
What ideas are the researchers presenting?
The researchers advocate for clinicians using a harm reduction approach to support clients interested in psychedelic use. While harm reduction can refer to a public health or social justice movement, it is also a method that has been integrated into psychotherapy for individuals engaging in various risky behaviours.
In clinical trials, psychotherapeutic support for people undergoing psychedelic-assisted treatment usually includes some preparation sessions, support during dosing sessions and a few follow-up or “integration” sessions after each dosing session to discuss the experience, all within a controlled environment. In a harm reduction approach, psychotherapeutic support would begin with providing resources or educating clients about the risks, benefits and alternatives to psychedelic substances to help them make informed choices about their use in a non-judgemental way. If a client chooses to pursue psychedelic use, the clinician may then focus on helping them plan for use that is safe and maximizes the potential benefits of the substance of choice. It would not include attending or facilitating dosing sessions, but it would include the same type of integration following substance use that occurs during clinical trials.
Of course, the types and level of risk associated with a clinician engaging in psychedelic harm reduction and integration therapy (HRIT) is dependent on local laws and law enforcement, as well as relevant professional licensing boards. Risks can range from harm to one’s professional reputation, to losing one’s professional license, to civil litigation or even criminal prosecution.
To lessen these risks, the researchers recommend clinicians:
- avoid facilitating access to illegal drugs, providing physical space in which to use illegal drugs or coordinating with underground psychedelic “guides”
- use clear language with clients about the boundaries of their clinical practice
- seek out training and supervision in the area of HRIT and consult with others doing this work
- investigate local laws, licensing requirements and attitudes toward psychedelics (keeping in mind that clinicians and clients who possess more power and privilege carry less risk of stigma and prosecution)
- get familiar with the research evidence concerning the use of psychedelics to treat mental illness and/or addictions (keeping in mind the lack of diversity among research subjects and the knowledge held by Indigenous groups who have used psychedelic substances for medicinal or religious practices for many generations before the invention of psychotherapy)
- reflect on their goals for clinical practice, their level of competency and privilege, and the level of risk they are comfortable with taking on.
How can this information be used?
This information can be used by therapists who work with clients seeking psychedelic experiences for personal or therapeutic purposes.
What future research is recommended?
The researchers recommend increasing efforts to develop ethical and professional guidelines for therapists interested in HRIT, including the development of a code of ethics.
About the researchers
Brian Pilecki 1, Jason B. Luoma1, Geoff J. Bathje 2, Joseph Rhea3, Vilmarie Fraguada Narloch4
- Portland Psychotherapy Clinic, Research, & Training Center, Portland, OR, U.S.A.
- Department of Counseling and Integrated Programs, Adler University, Chicago, IL, U.S.A.
- Attorney, Palm Springs, CA, U.S.A.
- Students for Sensible Drug Policy, Washington, DC, U.S.A.