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.

UPCOMING TRAINING EVENTS


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 11, 2022 from 12pm-2:00pm

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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.

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

May 13th, 2022Implementing Culturally-Attuned & Anti-Racist Psychedelic Therapy: Impact over Intention with Jamilah R. George, M.Div, M.S.