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A new framework for training psychedelic therapists
As thousands of patients enter clinical trials for psychedelic-assisted therapy, a crucial question emerges: Who will guide them through these profound experiences? A narrative review published in the Journal of Humanistic Psychology by Dr. Janis Phelps reveals that the success of psychedelic therapy depends as much on the guide as it does on the medicine.
For the first time, researchers have systematically identified six core competencies required for therapists working with psychedelic medicines. This comes at a critical moment, as MDMA and psilocybin approach potential FDA approval for conditions like PTSD and treatment-resistant depression.
The review identifies six essential competencies: empathetic abiding presence, trust enhancement, spiritual intelligence, knowledge of psychedelics' effects, therapist self-awareness, and proficiency in complementary techniques. These skills go far beyond traditional therapy training, incorporating elements of spiritual guidance, medical knowledge, and specialized psychological support.
As Phase 3 clinical trials advance and the possibility of legal psychedelic therapy approaches, the field faces an urgent need for qualified therapists. This comprehensive framework provides a roadmap for training the next generation of psychedelic therapy providers, ensuring that as these powerful medicines become available, they'll be administered by properly trained professionals.
From prohibition to a modern renaissance
From 1950 to the mid-1960s, over 1,000 clinical papers documented the use of psychedelics to treat over 40,000 patients, with promising results across multiple conditions. This golden age of research came to an abrupt halt with the Controlled Substances Act of 1970, which made psychedelic research nearly impossible.
The modern renaissance began in the 1990s, when the FDA opened the door to new studies. Organizations like the Multidisciplinary Association of Psychedelic Studies (MAPS) and the Heffter Research Institute led the charge, focusing on MDMA for PTSD and psilocybin for end-of-life distress. Their careful, methodical approach has paid off: recent clinical trials show remarkable success rates, with MDMA-assisted therapy helping 83% of participants no longer qualify for a PTSD diagnosis, and psilocybin showing significant promise in treating depression and anxiety in cancer patients.
However, this focus on proving the medicines' effectiveness has left a crucial gap in our understanding: what makes a skilled psychedelic therapist? As researchers focused on controlling for therapist variables to demonstrate drug efficacy, the art and science of psychedelic therapy guidance remained largely unexplored.
The six essential competencies
Through extensive review of clinical literature, case studies, and training manuals spanning decades of psychedelic research, Dr. Phelps identified six fundamental competencies that consistently emerged as essential for effective psychedelic therapy.
Empathetic Abiding Presence: At the heart of psychedelic therapy lies the therapist's ability to maintain what researchers call an "empathetic abiding presence." This goes beyond traditional therapeutic empathy, requiring a cultivated capacity to remain fully present and steady during intense emotional experiences. The therapist must embody a calm, witnessing presence that can hold space for whatever emerges, from profound spiritual experiences to challenging emotional episodes.
Trust Enhancement: Successful psychedelic therapy depends on three levels of trust: the participant's trust in the therapist, in their own healing capacity, and in the therapeutic process itself. Skilled guides help participants navigate unfamiliar psychological territory by normalizing challenging experiences and consistently demonstrating trustworthiness. This creates a foundation of safety essential for therapeutic breakthroughs.
Spiritual Intelligence: Unlike traditional therapy, psychedelic sessions often involve profound mystical or transpersonal experiences. Therapists must possess what the review calls "spiritual intelligence" - the capacity to understand and work with these experiences productively. This includes familiarity with various states of consciousness and the ability to help participants integrate profound spiritual insights into their everyday lives.
Knowledge of Physical and Psychological Effects: Guides must thoroughly understand the physical and psychological effects of psychedelic medicines, including potential risks and challenges. This encompasses everything from basic pharmacology to the creation of appropriate "set and setting" - the psychological and physical environment crucial for therapeutic success.
Therapist Self-Awareness and Ethical Integrity: The intensity of psychedelic therapy requires exceptional self-awareness and ethical clarity from practitioners. Therapists must maintain appropriate boundaries while working with participants in highly vulnerable states, manage their own reactions skillfully, and navigate complex therapeutic relationships with integrity.
Proficiency in Complementary Techniques: Successful psychedelic therapy often incorporates various therapeutic tools and techniques, from breathwork to somatic approaches. Guides must be versed in multiple modalities to support participants throughout the preparation, session, and integration phases of treatment.
Training tomorrow's guides: The 12 domains of study
The review outlines twelve essential areas of study and training for psychedelic therapy training programs:
- History of clinical research and legal status
- Neurobiology and pharmacology
- Best practices in set and setting
- Therapeutic relationships and ethics
- Supervised session observation
- Therapeutic models
- Complementary techniques
- Co-therapy methods
- Models of consciousness and mystical experiences
- Ceremonial and religious contexts
- Clinical supervision during internship
- Personal experience as a research participant
These domains form the foundation for comprehensive training programs now emerging at institutions like the California Institute of Integral Studies, which pioneered the first academically accredited certificate program in psychedelic-assisted therapy.
Implications for mental health care in the future
As psychedelic therapy moves toward mainstream acceptance, the need for qualified practitioners grows more urgent. The framework presented in this review offers a roadmap for developing the skilled guides needed to make this promising treatment modality safely available to those who need it.
The implications extend beyond individual treatment rooms. As Dr. Phelps rightly says, "The healing and transformational experiences to be found in psychedelic-assisted exploration in therapeutic and supportive sets and settings are a birthright." This suggests a future where psychedelic therapy could be integrated into broader mental health care systems, supported by a new generation of specially trained practitioners.
The challenge now lies in expanding training programs while maintaining the high standards these powerful medicines demand. As the field moves forward, these core competencies provide a foundation for ensuring that psychedelic therapy fulfills its promising potential for addressing mental health challenges that have long resisted conventional treatment approaches.
Click here to read the whole article:
https://www.researchgate.net/publication/318022461_Developing_Guidelines_and_Competencies_for_the_Training_of_Psychedelic_Therapists
Citation: Phelps, Janis. (2017). Developing Guidelines and Competencies for the Training of Psychedelic Therapists. Journal of Humanistic Psychology. 57. 002216781771130. 10.1177/0022167817711304.