Altered States of Context: A New Podcast about Psychedelic Science

Altered States of Context is a new podcast about psychedelics and psychotherapy hosted by Nathan Gates and Brian Pilecki.

Altered States of Context explores the uncertain fit between a medicalized view of individual mental illness and a psychedelic view of suffering and change, and explores the many possibilities, opportunities, and pitfalls that emerge from this union. Podcast guests include leaders within the field of psychedelic medicine who bring their expertise and perspective to help understand the past, present, and future of psychedelic-assisted therapy. Whether you are new to psychedelics or have been around the block a few times, this podcast is suitable for a wide audience. Nate and Brian also try to “keep it weird” by highlighting some of the aspects of psychedelic experience that make it so interesting, fun, and transformative.

The podcast particularly features functional contextualist approaches to psychotherapy, such as Acceptance and Commitment Therapy (ACT), and discusses how such approaches are a good fit for psychedelic preparation and integration. ACT and related approaches are being used in a number of studies on psychedelics and are going to be an important part of this burgeoning field.

New episodes are released every other Monday and can be found on most podcast platforms such as Audible and Apple. Please also check out Altered States of Context on Facebook or Twitter and provide feedback about the podcast or ideas for future episodes.

Nathan W. Gates, MA, LCPC is educated, trained and credentialed as a professional counselor, which is how he earns his living as a private practitioner in rural West-Central Illinois. His career and training have been inspired by insights from psychedelics medicine for more than 20 years. From earning his MA from Naropa University to finding his theoretical home beneath the umbrella of contextual behavioral science, he has consistently pursued an integrative understanding of the human condition. He believes that a central promise and challenge of psychedelic medicine is to create a fully integrated life. We are all called to make sense of our brief time on this planet and purposely serve that which we love. To that end, Nathan strives to weave his roles as psychotherapist, husband, homeschooling parent, ecological citizen, freelance psychedelic integration specialist, entrepreneur, permaculturist and cattle farmer into a sensible and coherent whole. His success in this endeavor is ultimately an open question, but it puts him in a position to learn a great deal from a very wide variety of human beings. This often leads to great conversations. He is also a founder of the psychedelic special interest group with the Association for Contextual Behavioral Science, which has been a tremendous wellspring for creative and ultimately fruitful psychedelic collaborations for people around the world. Additionally, he spoken at regional and international conferences on the usefulness of utilizing contextual behavioral perspectives to make sense of and integrate insights from psychedelic experiences.

Dr. Brian Pilecki is a clinical psychologist at the Portland Psychotherapy Clinic that specializes in the treatment of anxiety disorders (OCD, generalized anxiety, social anxiety, panic disorder), trauma and PTSD, and matters related to the use of psychedelics. He completed a post-doctoral fellowship at The Warren Alpert Medical School of Brown University and practices from an orientation based in Acceptance and Commitment Therapy (ACT). Brian also has extensive experience in the areas of mindfulness and meditation, and incorporates them into his therapy with clients. He is an active researcher and has published on topics such as anxiety disorders, mindfulness, and the relationship between theory and practice in psychotherapy. At Portland Psychotherapy, Brian is also involved in research in the use of psychedelics for the treatment of mental health problems.

What Do Licensing Boards Think of Psychedelic Integration Therapy?

Psychedelics are growing more popular for treating mental health problems and public demand for integration services is growing in sync with this demand. Many therapists have begun offering psychedelic integration therapy for clients who are already using or experimenting with psychedelics, but also have questions about legal and ethical risks involved in doing this kind of work. Psychedelic integration work is a relatively new practice and guidelines are still developing. Practicing in any new areas entail risk, so it’s important to think about how to manage it. A common question is, “What will my licensing board think?”

These two activities are particularly risky when it comes to licensing boards: 

  1. Helping clients access psychedelics, for example by referring them to an underground guide 
  2. Doing therapy with clients while they are under the influence of psychedelic substances that they obtained themselves.  

Both of these are likely to lead to licensing board sanctions if your licensing board finds out. They could even put you at criminal risk as an accessory to a crime or due to drug house laws that forbid hosting a place for people to use illicit drugs. 

It would be ideal if we could just ask our licensing boards what they thought, but licensing boards typically do not make generalized statements about ambiguous situations, especially in cases where there may be a legal or ethical gray zone.  

So, we are left thinking this through on our own. First off, we might consider What is the role of a licensing board? Licensing boards have a primary duty to protect the public and take disciplinary action against providers in situations such as: 

Becoming familiar with common types of licensing board violations can provide a better sense of how to practice within ethical boundaries. In evaluating your own practice, take some time to imagine how a licensing board might perceive what you are doing. To help mitigate risk around psychedelic integration therapy, here are some things to think through. Taking each of these steps is likely to reduce your risk of licensing board sanctions should a complaint be filed against you. 

  • Ethical violations 
  • Sexual misconduct 
  • Illegal activities 
  • Provider impairment 
  • Billing or insurance fraud 
  • Practicing outside areas of expertise 
  • Malpractice 

Stay within the law: With some exception, most psychedelics remain illegal. Therefore, do not help clients obtain access to drugs, or even access to other people who can supply drugs such as underground guides. Do not allow clients to attend therapy sessions while under the influence of drugs. 

Obtain education and trainingThe more training and education in the area of psychedelics that you have, the more you can argue that you are practicing within an area of competency. Be able to demonstrate that this is an area of expertise. 

Consult with others: If you choose to incorporate client usage of psychedelics into your therapy practice, consult with other therapists who are doing the same thing. This is especially important when you are confronted with situations or dilemmas that you aren’t sure how to respond to. 

Be clear with clients: Aiming for clarity in communicating with clients is key in reducing the risk that a client may misunderstand what you are offering. Make sure that clients understand what it is you can offer, and what it is you can’t offer.  

In the end, there is no guarantee of protection against disciplinary action by a licensing board. However, taking steps to lessen risk can allow you to provide psychedelic integration therapy to clients who have an increasing need for this service.  

Written by Brian Pilecki Ph.D. & Jason Luoma, Ph.D. 

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.

Acceptance and Commitment Therapy is Making Waves in Psychedelic Science

In case you missed it, a renaissance in psychedelic science is happening! In January, the Journal of Contextual Behavioral Science published a special issue in the area of psychedelic medicine.  Many of studies in this issue made the case for why Acceptance and Commitment Therapy provides such an appropriate therapeutic framework for conducting psychedelic-assisted psychotherapy. Namely, it seems that when used in safe and supportive settings, psychedelics may enhance psychological flexibility and therefore be useful in treating a wide variety of psychological problems including anxiety and depression. In addition, ACT is being used as the therapeutic framework in clinical trials of psychedelic assisted therapy at The Imperial College in the UK and at Yale/NYU in New York. ACBS members can download all these articles by logging into their member account at contextualscience.org first.

For a summary of the research on psychedelic assisted therapy, we just published the most comprehensive meta-analysis of placebo-controlled trials to date. This will give you a good overview of the research evidence so far and why people are excited about the potential of psychedelic-assisted therapy for a range of psychological problems.

While it will still be several years before psychedelics can be legally administered, it is currently possible for people to meet with a therapist to discuss psychedelic experiences they may have had on their own. These services are often called psychedelic integration and safety servicesand refer to the use of a harm reduction approach where clients can have a safe non-judgmental space to talk about their interests in psychedelics, receive support in learning about the risks and benefits of psychedelic use, and process any prior experiences. We offer these services at Portland Psychotherapy and while we do not facilitate access to psychedelic experiences in any way, clients are welcome to discuss their interest in the therapeutic use of psychedelics with a trained professional. We’ve also begun offering training on the topic as well.

Portland Psychotherapy is currently planning what we believe will be the first trial of psychedelic assisted therapy in the Pacific NW. The study will be a randomized trial studying MDMA-assisted psychotherapy in the treatment of adults with severe social anxiety. We are currently preparing our submission to the FDA for approval to run the trial and hope to contribute to the understanding of the mechanisms of action of MDMA-assisted therapy, which to this point has mostly been used in treating PTSD.

Finally, this year’s ACBS virtual world conference will include a workshop on psychedelic integration and harm reduction therapy, as well as a symposium with several recent papers related to psychedelic-assisted therapy. If you are a member of ACBS, please also consider joining the Psychedelic and Non-Ordinary States of Consciousness Special Interest Group (SIG) to find more ways to connect with like-minded peers and stay up-to-date with the latest in psychedelic science.

Written by Brian Pilecki, PhD & Jason B. Luoma, 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.

Jason is a psychologist who researches ways to help people with chronic shame and stigma and also works clinically with people struggling with those same problems.

UPCOMING TRAINING EVENTS


Acceptance & Commitment Therapy – An Experiential & Practical Introduction

Jason Luoma, PhD and Jenna LeJeune, PhD
November 13th and 14th, 2021 from 8:30am-4:30pm
at Hilton Garden Inn Portland Airport
This two-day in-person workshop provides a thorough overview of the theory, principles, and techniques of Acceptance and Commitment Therapy. It is intended for those who are relatively new to ACT and for those who have done some reading on their own about ACT but who may not have had the opportunity to participate in more experiential learning, observe models, or receive feedback while using the ACT model. Read More.


Ethical & Legal Considerations in Psychedelic Integration Therapy

Brian Pilecki, PhD and Jason Luoma, PhD
November 19th, 2021 from 9am-11am

There is an increasing demand from clients seeking therapeutic support in their personal use of psychedelics. However, many clinicians interested in psychedelic preparation and integration are unsure as to how to provide these services as psychedelics mostly remain illegal. In this workshop, we will outline legal and ethical frameworks relevant to providing therapy to clients around their personal use of psychedelics, as well as describe how harm reduction approaches are suitable for this developing clinical area. Read More.


De-Mystifying Self-As-Context in ACT: Practical Strategies for Clients

Brian Pilecki, PhD and Kati Lear, PhD
December 3rd, 2021 from 12pm-1:30pm

This workshop will outline how self-as-context can be used to conceptualize commonly discussed topics in therapy such as self-esteem, confidence, identity, and inner conflict. Participants will learn how to flexibly practice practical self-as-context interventions that can be used with clients, as well as have a chance to practice newly learned skills through structured role-play exercises in breakout groups. Read More.


Values in Therapy: An Intro to Working with Values from an ACT Perspective

Jenna LeJeune, PhD
January 21, 2022 from 12pm-2:00pm

This workshop will provide a theoretical and conceptual overview of values from a contextual behavioral science perspective. We will cover the “what”, “why”, “when”, and “how” of values within ACT. While we will also provide an overview of various values exercises and measures that can be used with clients, the emphasis in this workshop will be on providing a foundational framework that will help clinicians approach values work from a functional perspective rather than a primarily technique-focused approach. Read More.



Culturally Responsive Therapy: How to Apply Anti-Racist Values in Session

Christy Tadros, LPCC and RaQuel Neal, LCSW
February 4th, 2022 from 1:30pm-4:45pm
and February 5th from 9:00am-12:00pm

This 2 day 6-hour training will help therapists develop their ability to support clients from a different racial background than them, with a particular focus on Black, Indigenous and People of Color. Through a multicultural social justice framework, it will integrate research and clinical experience to teach a therapeutic model for rapport building, assessment, and treatment. This model is not a rigid therapeutic modality, but provides a contextual lens to build a strong, culturally grounded therapeutic relationship. It is a flexible model and can align with many therapeutic modalities, including a contextual behavioral approach to therapy. Read More.


Truffle Hunting: Bringing Values to Life in the Therapy Room

Jenna LeJeune, PhD
February 25, 2022 from 12pm-2:00pm

This brief workshop is designed to help clinicians deepen their values work with clients by shifting the focus from the content of values conversations to the quality of those conversation. By listening for and deepening the qualities of effective values conversations participants will get a taste for how more experiential and relationally-based values work can supercharge therapy. Participants will have opportunities to both observe demonstrations and practice in small groups with the benefit of feedback. Read More.


Values Prototyping: Using Action to Help Clients Explore Their Values

Jenna LeJeune, PhD
March 18, 2022 from 12pm-2:00pm

This workshop will focus on one specific experiential tool called “values prototyping” that helps clients learn more about their values through engaging in intentional valuing. As participants will hopefully already have a solid foundation of some of the core concepts of the values process in ACT, this workshop will dive right in on how to use values prototyping to help clients learn more about what they would choose to value in their life. You will have the chance to practice developing a values prototype in small groups with the benefit of feedback, so that by the end of the workshop you will be able to use this tool in your work with clients. Read More.


The Invitation to Change Approach: Helping Families Affected by Addiction

Jeff Foote, PhD and Cordelia Kraus, LPC, CADC 1, certified CRAFT clinician
May 13th and 14th, 2022 from 9:00am-5:00pm
at University of Portland, Terrace Room
This two-day in-person workshop will provide skills training for professionals focused on the process of working with clients who have a loved one struggling with substance use issues. The Invitation to Change Approach draws on CRAFT (Community Reinforcement and Family Training), MI (Motivational Interviewing), and ACT (Acceptance and Commitment Therapy) to provide a compassionate and collaborative way of working with the families and concerned significant others of people who struggle with substance use. Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

November 12th, 2021Psychedelic Research: Implications for Palliative Care and End-of-Life Existential Distress with Anthony Bossis, Ph.D.

December 10th, 2021Implementing Culturally-Attuned & Anti-Racist Psychedelic Therapy: Impact over Intention with Jamilah R. George, M.Div., M.S.

January 14th, 2022Psilocybin-Assisted Therapy of Major Depressive Disorder using Acceptance and Commitment Therapy as a Therapeutic Frame with Jordan Sloshower, MD, MSc

February 11th, 2022 – Drug-Drug Interactions Between Psychiatric Medications and MDMA or Psilocybin with Aryan Sarparast, MD