Therapist Competencies

Empathetic Abiding Presence

Elements of empathetic abiding presence include composure, evenly suspended attention, empathetic listening, responding to distress with calmness, and equanimity. To practice this one must be balanced and aware of the multiplicity of what unfolds moment to moment during the experience. This includes watching the breath, being alert, eyes open, ready to respond, keeping a positive attitude, and knowing when and when not to engage with the participant.

 

Cultivating empathic abiding presence requires significant inner work. Therapists must balance affective and cognitive empathy which is to say they must recognize and differentiate their emotions from those of the participant without being indifferent to them. The practice of empathic abiding presence is demonstrated when a therapist is able to remain focused on and supportive toward a participant regardless of the participant’s demeanor by listening and following the participant’s inner healing intelligence rather than the therapist’s expectations.

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Trust Enhancement

Trust is a crucial element in an optimal set and setting, creating psychological safety for the participant. When a participant is fully able to trust the therapist they are able to surrender to the experience, lower psychological defences, and endure challenging experiences that may arise in the session.

 

Therapists should model trust in all stages of treatment including trust of involved colleagues, the medicine itself, the participant’s healing intelligence, and their own abilities as a therapist. Trust is built when a therapist is able to demonstrate confidence balanced with humility, compassion, and a thorough knowledge of the range of experiences of the treatment.

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Public Offerings

We encourage the general public to check out the offerings of the Portland Psychedelic Society. In the future, we will likely offer both psychedelic harm-reduction and integration classes as well as mental health and wellness webinars and live workshops.

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Knowledge of the Physical and Psychological Effects of Psychedelics

Psychedelic therapists should be well versed in the neurobiology and pharmacology of any substances used in their practice. They should also demonstrate a thorough understanding of the subjective and phenomenological experiences that these substances can create. Though expertise may vary by professional background and interdisciplinary teams are optimal, everyone involved in psychedelic therapy should have a sufficient comprehension of the anatomy and physiology of drug effects, dosage variables, side-effects, contraindications, drug interactions, safety precautions, and set and setting variables.

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Therapists should be competent in risk assessment and in techniques to mitigate acute distress such as trauma reactions, dysphoria, strong emotions, and somatic expressions. They should also be knowledgeable of hallucinogen persistent perception disorder (HPPD) and child and adult developmental theories. Therapists must also possess the skills necessary to maintain safety for all stakeholders including keeping participants onsite despite their potential desire to leave, to prevent them from harming themselves or others, and to remain calm in the event of any disruptions.

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It is important that therapists acquire this knowledge and skill set from a variety of sources. Therapists should be up to date on recent findings in peer-reviewed medical literature from clinical trials, case reports, and evidence-based theories. Also of significant importance is the knowledge acquired from traditional sources from anthropological and ethnobotanical studies, shamanic practices of indigenous peoples, and other sources of knowledge. These traditions often provide time-honored ceremonial practices and insights with directly beneficial application. All such insights or practices should be applied in a culturally sensitive way that honors rather than appropriates from the originating culture. It is also of utmost importance that therapists acquire first hand, experiential knowledge of the substances that they use therapeutically.

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Self-Awareness and Ethical Integrity

Psychedelic-assisted psychotherapy has many similarities as well as differences to other forms of psychotherapy. A therapist must have sufficient self-knowledge to recognize transference and countertransference which can look different during drug sessions than typical psychotherapy. Knowing when to use in-the-moment transference for therapeutic benefit and when to not reinforce or respond to it is a benchmark of the mature therapist. Countertransference or any preconceived notions of the therapeutic process that the therapist may have should be noticed and placed in check. This allows the participant to access their own healing intelligence without being clouded by the therapist’s expectations.

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Self-awareness is also demonstrated when a therapist exercises restraint in over idealizing their perceptions of a participant’s experience, meaning making, or their own role in the therapeutic process. This may include recognizing an impulse to act impressively or demonstrate knowledge or power. Inherent in any professional service there is a power differential that takes place. That difference is further amplified by the vulnerability that is created by participants entering into a psychedelic state. Recognizing this power and exercising self-awareness is a foundational piece of professional integrity and ethical conduct.

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Special care should be taken to recognize potential ethical pitfalls. This may include conscious or unconscious biases against members of minority or otherwise disempowered groups, financial incentives, sexual exploitation, or social status. Therapists should be compliant with the ethical guidelines of their respective professions as well as the standards of this unique form of therapy as proposed by, for example, the Council on Spiritual Practices, Usona Institute, Holotropic Breathwork, or others. Regular continuing education on cultural competency is also necessary.

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Transpersonal Awareness

Because of the range of experiences that occur in psychedelic states it is imperative that a therapist doing this work understands the possibilities. One need not share the beliefs or interpretation of experiences with the participant so long as the participant’s beliefs can be held with respect and navigated for their benefit. Conversely, the therapist should refrain from imposing their own world view on a participant. Enthusiastic consent for the sharing of any such knowledge or imagery is important in protecting those with religious trauma as well as building trust with those of a more materialist worldview.

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For most, psychedelic experiences are spiritual even if other, less charged terms are used to describe it. Therein lies their transformational potential. For a therapist to be effective in guiding participants through their experiences and integrating them into wisdom, they must understand the territory. This could mean, but is not limited to knowledge of concepts around reincarnation, archetypal reality, yogic, Buddhist, or mystic traditions. Experience with some form of meditation and mindfulness practice is mandatory. Again, it is not necessary to hold any cosmology as true in order to be effective, but fluency in the language of these concepts will improve outcomes.

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The essence of this competency is about the embodiment of wisdom. There is no substitute for personal experience. The cultivated therapist, therefore, will have experienced personal transformation in their life and have first person knowledge of the utility and application of theory and technique, be it psychedelic or otherwise. Furthermore, it is an ongoing process of continual cultivation and assimilation of skills. The indicators of a good therapist on this path, at very least, are authenticity, patience, compassion, and gratitude.

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Proficiency in Complementary Techniques

There are many forms of therapy that are or could be used in conjunction with psychedelic medicine. However, the psychedelic experience is best paired with techniques that integrate holistic and somatic experiences. While no single school of therapy will fully prepare the student to do psychedelic therapy, the psychedelic therapist will be well equipped if they have multiple tools to draw from for both the preparation, integration, and drug sessions. The following is a non-comprehensive list of compatible and complementary techniques that therapists are encouraged to seek additional training in, especially those without prior psychotherapy skills.

 

Somatic techniques

• Stress inoculation

  • Therapeutic body work and touch

  • Sensing and focusing

  • Eye-gazing

• Integrative Somatic Therapies

  • Hakomi

  • Sensorimotor

  • Somatic Experiencing​

• Holotropic Breathwork 

• EMDR

• Guided Affective Imagery 

• Bonny Method of Guided Imagery and Music 

• Logotherapy, existential, and narrative therapy

• Post-hypnotic suggestions

• Internal Family Systems work

• Gestalt, voice dialogue, and psychosynthesis

• Shadow work 

• Mindfulness and Meditation practices or teacher trainings

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The 12 Curricular Domains of Study for Psychedelic Therapists

The domains described below are an adaptation from Janis Phelps (2017) and are used to ensure a robust education for clinicians wishing to engage in psychedelic therapies.

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1. History and anthropology of psychedelic and entheogenic medicines used in indigenous traditions and throughout history

2. The history of clinical research and current legal status of psychedelic-assisted therapy

3. Harm reduction in recreational and ceremonial use of psychedelics in religious and community settings

4. Sets and settings: preparation, psychedelic session, integration 

5. Therapeutic relationships: transference, boundaries, ethics, and self-care

6. Neurobiology, neuropharmacology, drug disposition, and drug interactions

7. Variations in therapeutic models: client-centered and psycholytic psychedelic therapy

8. Experiencing: Observation of psychedelic sessions, role-playing, and receiving the therapy as a participant

9. Complementary therapeutic techniques in psychedelic-assisted therapy

10. Individual and group clinical supervision during an internship as a psychedelic therapist 

11. Current models of consciousness, transpersonal awareness, and mystical experiences

12. Co-therapy methods and inter-professional skills for working on multidisciplinary teams

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Reference

Phelps, J. Developing Guidelines and Competencies for the Training of Psychedelic Therapists. Journal of Humanistic Psychology 57, 450–487 (2017).