As recent trials of psychedelic-assisted psychotherapy enter the last phase of testing, the coming need for many trained therapists and guides seems inevitable. Until recently, the only opportunity to train and work legally as a psychedelic therapist was in clinical trials. That will likely change over time as expanded access becomes the next step for current trials (evaluating MDMA and psilocybin) and if psychedelic-assisted therapies become FDA approved.
Many people are looking for information about psychedelic therapy and opportunities to become guides or therapists after reading Michael Pollan’s new book How to Change Your Mind: What the New Science of Psychedelics Teaches Us about Consciousness, Dying, Addiction, Depression, and Transcendence . Providers are seeking trainings to become more informed about psychedelic experiences. They also want to know how to become certified to administer psychedelics in clinical trials and potentially post approval.
Still, there remain many unknowns about what training programs outside of the drug sponsors will be acceptable by FDA to dispense MDMA or psilocybin post-approval. FDA has never regulated psychotherapy, but medical devices often require training in a certified program. Demonstration of competency and maintaining of the acquired skills is required for compliance with regulatory agencies. Transcranial magnetic stimulation is one example of a specialized device with specific training requirements. It’s not yet known how FDA will regulate trainings for psychedelic-assisted therapies.
When Can I Offer Psychedelic-Assisted Therapy?
The FDA may approve MDMA for PTSD treatment as early as 2021, as MAPS has projected based on an optimistic (and likely realistic) finding of significant and positive results from two on-going Phase 3 trials. If so, thousands of therapists and doctors will be needed to meet the increased demand and opportunity for greater access. PTSD can be a difficult to treat condition with many individuals not accessing or responding to available treatments, so this call for expanded access will be an exciting opportunity to provide care to a much larger number of people who are currently suffering.
The next likely candidate for FDA approval after MDMA is psilocybin for the treatment of depression. In late 2018, the FDA granted Breakthrough Therapy designation for psilocybin for treatment-resistant depression, which will help expedite its approval as long as results from clinical trials remain positive
What are the Options for Training in Psychedelic-Assisted Therapy?
Despite many unknowns, some training programs already exist, and many more are expected to become available.
In 2015, the California Institute of Integral Studies (CIIS) started a formal training program called the Certificate in Psychedelic-assisted Therapies and Research. The hybrid residential, in-person and online curriculum is a roughly 9-month course with rotating guest lecturers and a weeklong retreat. This program is broad in focus, interdisciplinary, and covers classic psychedelic medicines (e.g., psilocybin, ayahuasca, peyote, LSD) as well as the newer medicines (sometimes labeled empathogens or entactogens) like MDMA and ketamine.
To enroll in the CIIS certificate program, interested individuals must fill out an application, complete an interview, and receive an offer from the program’s selection committee. Applicants are required to be a licensed mental health or medical professional, counseling attorneys, or ordained or commissioned clergy and chaplains. The tuition cost is currently set at $10,000. There are several information sessions scheduled throughout the year to explain more and answer questions about the program. Each cohort generally starts in the Spring and graduates in December.
More substance-specific trainings also exist. In anticipation of Expanded Access approval, the Multidisciplinary Association for Psychedelic Studies (MAPS) has now posted an application for the MDMA Therapy Training Program with an invitation to apply. Training is currently prioritized for providers who would likely qualify for the Expanded Access program. If accepted by FDA, more clinics will open for MDMA-assisted psychotherapy for PTSD treatment during expanded access. Requirements for clinics and providers are provided as is a forum for providers to connect with others who are interested in starting up MDMA clinics.
While no strict criteria have been released about who would qualify, the MAPS website states that at minimum one person in the therapy team pair must be licensed to conduct psychotherapy. While the other person does not need to be licensed, they “must display training in therapeutic relationship, ethics, and traumas.”
Each clinic also needs a Drug Enforcement Administration (DEA) license, which requires a licensed medical provider who can prescribe (e.g., medical doctor (MD), doctor of osteopathy (DO), or other eligible prescriber). MAPS encourages interested providers to apply now in preparation for the expected post-FDA approval. The cost for training and supervision is currently set at $9,000.
Other industry drug sponsors, such as Usona Institute and COMPASS Pathways, and researchers at various universities have devised their own trainings and ways to prepare clinicians to work on clinical trials of psychedelics. At this time, there are no details posted on websites about what the trainings consist of, but journal publications have described procedures, such as the Usona Guide Manual .
What Do You Learn in the Training Programs?
The CIIS program is approximately 180 hours and covers a wider range of topics related to psychedelic therapies. More time is spent on historical and philosophical aspects of non-ordinary states of consciousness, including non-substance induced ones as seen in Holotropic Breathwork and deep meditation. The learning objectives are focused more broadly on psychedelics and empathogens, rather than specifically on MDMA-assisted psychotherapy .
The MAPS program is a 5-part course with didactic training and experiential learning components. Trainees start with online e-learning modules covering MDMA pharmacology and its clinical safety profile, an introduction to the MDMA Treatment Manual , and some basics about clinical trials. A week-long, in-person training follows where MDMA session videos are viewed and discussed with the therapists who treated the study participants. The next parts involve role playing, observing MDMA sessions, and then treating a patient with supervision and evaluation from the trainers.
Some parts of these two programs overlap significantly. For example, the weeklong in-person retreat for both programs focuses on MDMA-assisted psychotherapy and are taught by Michael and Anne Mithoefer, MDMA study therapists and lead instructors at MAPS.
What are the Experiential Learning Components of Trainings?
Dating back to the first research studies of LSD in the 1950s, a first-hand experience in a non-ordinary state of consciousness has been perceived valuable for administering psychedelics. It’s thought that by understanding the drug effects, the therapists can more readily establish empathetic rapport and presence to support a person’s therapeutic process. They can also be better able to respect the power and significance of these experiences.
For indigenous communities, it’s deemed essential that shamans or ceremonial leaders have personal experience with the psychoactive plants they give to others. But in Western medical practices, it is rarely the case that doctors are encouraged (or even allowed) to take a medication to understand the effects a patient would feel.
Thus, psychedelics present a new challenge for psychiatric medical training. If there is value in having a personal experience, then how can providers legally pursue an experiential learning component to their training? To date the evidence of potential benefits of doing so remain anecdotal due to lack of approved controlled research.
CIIS’s program is an “above board” program with no use of illicit substances. MAPS, however, received approval in their sponsored, FDA-approved study that allows trainees in their program to receive one dose of MDMA in a clinical setting if they also are eligible for the research study as a participant. As with all clinical trials, participants in the approved study must meet criteria to enroll and provide data to assess potential benefits or harms. Even if they meet the basic inclusion criteria, trainees are not required to undergo an MDMA session. Some might have conditions that would counter-indicate the use of MDMA. For example, pregnant women or individuals with cardiac disease would be excluded. Trainees may also simply not want to take a drug.
As alluded to earlier, Holotropic Breathwork is one alternative to reach a non-ordinary state of consciousness without consuming any substance. Through accelerated breathing and stimulating music, a person can enter into states similar to ones induced by drugs.
CIIS incorporates Holotropic Breathwork as experiential learning in their program. Therapists may consider alternatives, but they should do so while considering carefully the legal and ethical guidelines of their licensing board and professional organizations. Psychedelic Support and its partners do not encourage or condone the illegal use of substances.
Given this reality, other possible alternatives for experiential learning do exist. They include attending plant medicine ceremonies in other countries where it is legal, shamanic drumming/chanting practices, or extended meditation. Research is needed to understand if first-hand exposure by therapists impacts patient outcomes, and if so, what type of drugs or experiences are best for training. We encourage therapists exploring this new area to consult with their colleagues and even seek out legal counsel as they deem appropriate.
Taking entheogens can be like air travel: people do it all the time, it’s usually fine, but when it’s not fine, it’s sometimes very bad. We’ve been there. And that’s where an experienced guide can make the difference in the outcome.
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