Understanding Risks in Practicing Psychedelic Harm Reduction and Integration Therapy: Advice for Clinicians

You may have noticed that the buzz around psychedelic assisted therapy has grown by leaps and bounds within the last several years. Many therapists are eager to become involved in this newer form of mental health treatment, though psychedelics remain largely illegal. Using a harm reduction approach, some therapists have begun to incorporate client’s personal use of psychedelics into therapy by offering a safe space to prepare for or integrate psychedelic experiences. However, many therapists may be cautious to practice in this area due lack of clarity about potential risks for themselves. Here are some tips that might be helpful when considering practice in psychedelic harm reduction and integration (HRIT).

Know the law. First, most psychedelics are illegal. Therefore, clients who discuss plans to use psychedelics will likely be discussing plans to engage in an illegal activity. While therapists are unable to encourage illegal behavior, a harm reduction approach can be used to help clients identify potential risks and benefits and make their own informed choices. Even if you are in one of the increasing number of cities where psychedelics have been decriminalized, they remain federally illegal. The legal risks for working with psychedelics will vary by your local jurisdiction. If you want to do integration work around psychedelics, it’s a good idea to consult with a local attorney who knows criminal defense so you can understand how risky it is in your area to do this work.

Consider your licensing board. It is helpful to consider how practicing HRIT may be perceived by your licensing board. Will they consider this outside your scope of professional expertise? What happens if a client has an adverse event involving psychedelics after one of your harm reduction sessions? Licensing boards are unlikely to give direct approval or permission to practice HRIT.  Nonetheless, it still is helpful to anticipate how your own board may view such therapy.

Consider your norms. When deciding whether to practice HRIT, it is helpful to consider the norms of the area you live in. Geographic locations that are more politically conservative or mental health settings that are more traditional may confer greater risk.

Decide for yourself. Practicing HRIT involves some degree of legal and regulatory risk. We suggest that therapists reflect on the level of risk they are willing to take on given their own circumstances. For example, therapists who are not trained in harm reduction or who do not feel comfortable engaging in helping clients plan how to stay safe when using psychedelics could consider limiting services to psychedelic integration, or therapy that is focused on helping clients after they have already used psychedelics.

Get prepared. If practicing HRIT is of interest to you, there are several things that you can do to prepare. First, identify gaps in education or knowledge and seek out training opportunities to address such gaps. Second, consult with therapists who are practicing HRIT to learn more about how to incorporate this newer clinical area into your practice. Third, stay up to date. This is a rapidly evolving clinical area that is likely to develop more fully over the next several years. One option for learning more is our TRIPS Seminar Series, which can help you get up to speed.

As more people are using psychedelics for personal growth and therapeutic purposes, there is a greater need for therapists to provide support and information. Taking the time to learn about potential risks as a therapist can be helpful in deciding whether this is right for you.

Written by Brian Pilecki, PhD

Dr. Brian Pilecki is a licensed clinical psychologist who earned his Ph.D. from Fordham University and completed his postdoctoral training at the Warren Alpert Medical School of Brown University. He specializes in the treatment of anxiety disorders, trauma and PTSD, and matters related to the use of psychedelics. Additionally, Dr. Pilecki has experience in mindfulness and meditation and practices primarily from an orientation based on Acceptance and Commitment Therapy (ACT). He is also engaged in scientific research on psychedelics.

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