Harm Reduction & Integration Therapy (HRIT)

Harm reduction and integration therapy (HRIT) can help clients, but pose risks for clinicians. Learn how to stay safe and help clients heal.
By Jason Luoma, PhD
By Brian Pilecki, PhD
June 21, 2021(Updated: June 28, 2021)

Harm reduction and integration therapy (HRIT) has the potential to support clients’ healing through incorporating psychedelic experiences into therapy. However, it is not without risk for clinicians. Join Brian Pilecki, PhD and Jason B. Luoma, PhD as we understand risks and learn best practices for practicing HRIT.


Many therapists are eager to become involved in the clinical application of psychedelics. 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 to 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 therapy (HRIT).

Image Credit: Tingey Injury Law Firm

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. So, 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 & HRIT

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.

Image Credit: Romain Dancre

Consider your norms

When deciding whether to practice HRIT, it is helpful to consider the norms of the area you live in. Consequently, geographic locations that are more politically conservative or mental health settings that are more traditional may confer greater risk.

Decide for yourself in practicing HRIT

Practicing HRIT involves some degree of legal and regulatory risk. Thus, 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 for HRIT

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.

This blog was based on a recently published paper entitled Ethical and Legal Issues in Psychedelic Harm Reduction and Integration Therapy [1] that included consultation with experts in the field of harm reduction, law and criminal defense, and ethics. You can also learn more by attending workshops we run on this topic.

References

  1. Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal18(1), 1-14.

Published by:
Jason Luoma, PhD
Jason Luoma is a clinical psychologist and CEO of Portland Psychotherapy in Portland, OR and a researcher on the topics of shame, self-stigma, and the application of ACT and psychedelic assisted therapy. He is currently organizing a clinical trial of MDMA-assisted psychotherapy for social anxiety disorder and recently organized a special section on psychedelic assisted therapy and contextual behavioral science. He has over 60 publications including co-authoring two books: Learning Acceptance and Commitment Therapy  and  Values in Therapy: A Clinician’s Guide to Helping Clients Explore Values, Increase Psychological Flexibility, and Live a More Meaningful Life. His work on shame and compassion can be read at www.actwithcompassion.com.
Brian Pilecki, PhD
I am a licensed clinical psychologist located at Portland Psychotherapy in Portland, Oregon. Learn more about my psychedelic harm reduction and integration services on my profile page in the Psychedelic Support Network. I am also involved in research on the use of psychedelics for the treatment of mental health problems, including a trial investigating MDMA for the treatment of social anxiety disorder and also providing training on psychedelic harm reduction and integration. Visit my website to learn more.

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