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

Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 21, 2021 from 12-2pm

This workshop provides a chance to learn concrete methods for conceptualizing cases from the perspective of Acceptance and Commitment Therapy. Formulating a useful case conceptualization is a foundational clinical skill that is essential in delivering effective treatment, and one that can be often overlooked in the process of working with clients. Participants will learn several formats for doing formal case conceptualization outside of session as a means to further develop knowledge and skill with ACT theory, as well as to learn a means to enhance treatment planning. The importance of ongoing case conceptualization throughout a course of treatment will be emphasized, as well as common pitfalls in conceptualizing client problems. Participants will also have a chance to practice newly learned skills with a case in breakout groups. Read More.


Lunchtime Panel Discussion: Psilocybin Therapy and Mental Health Care in Oregon: What is Happening and Where do We Need to Go from Here?

Moderated by Brian Pilecki, Ph.D. with Ingmar Gorman, Ph.D, Kelly Sykes, Ph.D, Alan Davis, Ph.D, Aja Molinar, and Sam Chapman
May 28, 2021 from 12-1pm

Oregon Voters have recently approved a measure that will pave the way for the legal administration of psilocybin by state credentialed providers to begin in 2023. In this panel discussion, leading advocates, psychedelic therapy researchers, and psychedelic therapist training providers will elaborate on the implications during a moderated panel discussion and answer audience questions. Presenters will give an update on the status of the Oregon Psilocybin initiative, particularly as it relates to the training of facilitators, and will describe ways local therapists can get training in the practice of psilocybin-assisted therapy. Read More.


ACT Precision Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Help You be Focused and Strategic in Your Interventions

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
June 18, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop focuses on helping you use ACT theory & in-session clinical markers to make more precise and strategic interventions. The main goal of this workshop is to help you become more adept at identifying in-session client behaviors that are indicators for particular ACT processes that are likely to be most relevant. The workshop uses a process we call ACT Circuit Training, which involves intensive analysis of a video of an ACT session and intentional practice in conceptualizing client behavior and generating possible ACT responses, followed by discussion and feedback. Read More.



Developing the ACT Concept of Defusion in Kids and Teens

Julianna Sapienza, Ph.D, LP
June 25, 2021 from 12-1:30pm

Cognitive restructuring is a concept that is useful for many patients, but many others really struggle with fighting or changing their negative thinking patterns. This 1.5 hour hands-on workshop is designed to introduce child and adolescent practitioners to defusion, an ACT concept that helps patients drop the struggle with their thoughts while also not buying into them. You will learn all about defusion, how to introduce the concept to child and teen clients, and how to use your creativity to make these skills effective for your clients. Read More.


ACT Agility Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Increase Flexible Responding

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
July 16, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop is intended to help therapists be more flexible and nimble in their use of ACT processes, strengthening their ability to fluidly shift as needed between processes within sessions. Therapist learning ACT often develop tunnel vision, focusing too much on particular processes or responding rigidly when more flexibility is needed. 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.

May 14th, 2021  Research on MDMA and Psychedelic-Assisted Therapy: An Overview of the Evidence for Clinicians with Jason Luoma, Ph.D.
June 11th, 2021 Becoming a Psychedelic-Informed Therapist: Toward Developing Your Own Practice with Nathan Gates, M.A., LCPC