Finding the best fit therapist for you can be a daunting task, whether or not the work involves psychedelics. In this article, Dr. Kile Ortigo, PhD and Dr. Alli Feduccia, PhD, share insights into finding the best therapist for you – navigating the degrees of health professionals, reflecting on your own needs, listing questions to ask when interviewing a therapist, and more – with specific things to consider when seeking a psychedelic integration therapist.
As the psychedelic psychotherapy field continues to blossom, clients and therapists alike are realizing the breadth of approaches available. Although psychedelic research has used a general structure of preparation, psychedelic experience, and integration, therapists can approach each of these phases differently. With the exception of ketamine-assisted psychotherapy, the aspect of psychedelic psychotherapy that is currently available to the community consists only of harm reduction and/or integration services. This restriction is due to the Schedule 1 classification of the classic psychedelics (psilocybin, LSD, DMT, ayahuasca, etc.) and MDMA. Even when focusing on legally available integration services, we’ve seen a variety of approaches to the work.
Finding the best fit in a therapist can be a daunting task, whether or not the work involves psychedelics. The fundamental question asked is, “What type of therapist would be best for me?” Each person can answer this question in very different ways. Certainly some therapists are more skilled than others, but skilled in what? Would you like someone who is trained in treating trauma? What about a specific type of trauma—like childhood abuse, military sexual assault, or serious car accidents? Alternatively, do you feel a male therapist would best help you examine your relationship to masculinity? Or perhaps a gender specialist who can help you explore your gender identity, expression, and relationship dynamics? Maybe you just want a kind therapist, someone who will help you grow but will do so with gentleness.
These kinds of questions are important and often endlessly nuanced. The good news is that beyond identifying a specific area of specialty, most people can make an intuitive decision upon meeting a potential therapist. This intuition can incorporate many elements of your experience like your sense of trust in the therapist, their ability to hear and understand you, and your hope in the therapeutic potential of working together. All of these factors increase the likelihood of you benefiting from therapy with the particular therapist.
Finding the best fit in a therapist can be a daunting task, whether or not the work involves psychedelics. The fundamental question asked is, “What type of therapist would be best for me?”
While most of the recommendations here apply to finding a professional for any reason, there are some specific things to consider when seeking a therapist for psychedelic integration. We’ll start with commonly asked questions about different types of professionals and then move into general tips and specific questions to ask yourself as you search for the right fit.
What do the degrees of mental health professionals mean?
You’re not alone if the alphabet soup following a person’s name is more confusing than informative. The letters are abbreviations signifying the credentials and education of the individual. These professionals undergo varying types and lengths of training to acquire different areas of expertise. The first place to start in choosing a mental health professional is to understand what your needs are and what type of professional is best suited to work with you. Depending on the situation, sometimes people will see a combination of professionals.
Oftentimes professionals have additional certifications that aren’t usually listed after their name. In the world of psychedelic psychotherapy, for example, a select few individuals have completed an extensive training program in this area of specialty. One such program is the California Institute of Integral Studies’s (CIIS) Certificate in Psychedelic-assisted Psychotherapies and Research.
Let’s explore some common examples and what these types of professionals offer. Keep in mind these are broad generalizations, so we encourage you to ask any potential therapist about their specific background. All licensed providers must have supervised experience, pass state exams related to their profession, and maintain continuing education credits to maintain their licenses.
A psychiatrist is a medical doctor (MD) with specialized training in how to diagnose, manage, and treat mental health conditions. They usually work from a medical model, medication management framework, but some are trained in specific models of psychotherapy as well. Psychiatrists can assess whether symptoms stem from physical or psychological imbalances, or a combination. Setting them apart from other mental health professionals, psychiatrists can prescribe medications.To become a psychiatrist in the United States, people must first earn a medical doctorate and then complete a four-year residency in psychiatry. Psychiatrists are required to have a state license to practice and are eligible for board certification. There are many subspecialties within this field, such as child psychiatry or addiction psychiatry, which all usually require additional training, like post-residency fellowships, followed by board certification.
Clinical Psychologist (PhD, PsyD)
Psychologists who provide clinical services traditionally earn doctorates of philosophy (PhDs) in clinical psychology. Most PhD psychologists are trained in both evidence-based clinical work and mental health research. PsyD psychologists focus primarily on clinical training. These differences in degrees are generalizations, and individual programs can emphasize certain aspects of training more than others, regardless of the degree earned. Psychologists can offer a range of services and work in clinical or research settings. They undergo extensive training (similar in length to MDs) to obtain a doctorate and state license. In addition to providing individual, couple, group, and family therapy, they can administer and interpret psychological assessments in clinical or academic settings. They also can conduct psychological research and teach college or graduate students. With the exception of five states (Louisiana, New Mexico, Illinois, Iowa, and Idaho), psychologists do not prescribe medications. In addition to attaining an advanced degree, they must complete many hours under supervision during and after their degree program to obtain a state license to practice. Many psychologists also complete fellowships to specialize further, for example in treating trauma, substance use, severe mental illness, or working in specific medical settings like primary care, palliative care/hospice, or pain management clinics.
Licensed Clinical Social Worker (LCSW)
Licensed clinical social workers earn a Master of Social Work degree (MSW) and can perform several similar services as other mental health professionals, including clinical intake evaluations and specific interventions for mental health conditions. They often take a systems approach, working with individuals in the context of their families and communities. Licensed clinical social workers (LCSWs) can deliver therapy (if trained to do so) and/or oversee case management and help connect their clients to appropriate agencies and services. Social workers work in a variety of settings ranging from public schools to hospitals and rehabilitation facilities. After graduating with an MSW, states require additional supervised training (usually 2-3 years) to become licensed as an independent provider.
Licensed Marriage and Family Therapist (LMFT) & Licensed Professional Clinical Counselor (LPCC)
Beyond an MSW, other masters-level degrees exist for professionals who want to focus on providing clinical services. As the name implies, licensed marriage and family therapists (LMFTs) work with individuals and their relational systems (families, support networks) to treat mental and emotional problems. Licensed professional clinical counselors (LPCCs) work also provide counseling for mental and emotional issues or disorders, and are equipped to offer a variety of services including diagnosis, preventative psychoeducation and harm reduction. LMFTs and LPCCs obtain a master’s degree from an accredited program, and then undergo roughly 2-3 years of supervised clinical work. Afterwards, they can take their state licensure exams.
Unlike the licensed professionals already described, mental health coaches are not regulated by state licensing boards. Some (but not all) self-designated coaches complete a certificate program, but these programs are of varying lengths, do not have standardized training content or well-defined competencies. All professionals should be evaluated on their training and expertise, regardless of having a license or not. However, coaches may require additional scrutiny to ensure they are appropriately equipped to provide the services you need. Rarely do coaches have any high-level training in treating clinical disorders or symptoms and are not licensed by the state to do so. With that being said, coaches can be effective for supporting behavioral changes and providing a motivational framework for meeting basic life or career goals.
How can I know what I’m looking for in a therapist?
If you’re new to therapy, it can be hard to know where to start. The best source of information can be yourself. Below are some questions to reflect upon as you consider what you’re looking for in therapy and in a therapist.
- Am I currently experiencing any physical and/or psychological symptoms? How often do the symptoms occur and how much are these symptoms affecting my daily life?
- Have I been previously diagnosed with a mental health condition or disorder? Do I want to be assessed or re-evaluated?
- What do I hope to get out of working with a mental health professional? What are my goals and intentions?
- How do I want to work with mental health goals? Do I only want to try out medications? Do I want to focus on therapy first? Or, do I want to try a combination?
- Do I want to see a professional with special expertise or knowledge on specific topics?
- If I had previous experiences with mental health professionals, how did it go? What was helpful? What didn’t work so well? What might I look for that’s the same or different than in my previous experiences?
- What is my budget? What services will my insurance cover? Am I willing to pay more for a specialized or trained provider? If so, how will I budget for this expense?
- How much time can I dedicate to therapy sessions? Do I have a preference for in person or online telehealth sessions?
- Do I have preferences for my therapist’s gender, ethnicity, age, sexual orientation, or religious/spiritual background?
What about psychedelic integration services?
The above questions are still relevant when finding a therapist for psychedelic integration. However, additional questions may be worth reflecting upon too.
- What specific psychedelic substances have I used that I’d like to integrate?
- Did I have a difficult psychedelic experience that I’m still struggling to make sense of?
- Do I have strong beliefs about the psychological, spiritual or religious content of my experiences? Does my therapist need to believe any of these same things, or is it okay for them simply to be knowledgeable about the full range of possible experiences and interpretations?
- Do my needs for integration center around specific domains of my life—like my relationships, my work, my physical well being, my relationship with my body, or my spirituality?
- Am I looking for legal, guided experiences? Have I considered enrolling in a research study (if available) or traveling to another country? Or, would ketamine-assisted psychotherapy possibly be a healing approach to my goals?
- Am I looking for a provider with knowledge about what medications or medical conditions have additional risks for psychedelic users?
How can I find a therapist?
The following are general tips for searching and finding a therapist as well as reflection questions to consider after speaking with a potential therapist.
- Check out online directories, such as ours at Psychedelic.Support.
- List things to look for (education, state-specific licenses, specialties, types of sessions), review professional websites, and read online reviews—though note that reviews are rarely available or reliable due to complications with maintaining client confidentiality.
- Look at any publicly available articles, blogs, books, or talks authored by the therapist. Do these resonate with some of your experiences or goals?
- Ask friends and families for recommendations.
- Narrow down your criteria – gender, therapeutic orientation, cost range, subspecialities, and so on.
- Ask for a phone or in-person consultation before you commit to working with a specific therapist.
- What do you notice about their communication style, personality, and knowledge? If someone gives you a negative vibe, pay attention to that feeling even if you can’t exactly explain it.
- Try a session or two, and if you aren’t feeling supported or safe, seek a different therapist. Don’t hesitate to shop around.
When I meet with a therapist, what should I consider asking them?
Either over the phone or in person, talking with a therapist will give you an opportunity to ask your own questions. Not all therapists will answer all of these questions, but it doesn’t hurt to ask if it’s important to you. The therapist can tell you if they feel comfortable answering. Here are some questions to consider.
- What are your areas of expertise?
- What is your experience working with someone with my symptoms or my therapeutic goals?
- What is your therapeutic orientation? How do you approach psychedelic integration?
- Are there specific skills or practices you recommend to your clients? What are they, and why do you think they might be useful for me?
- Have you been in therapy before?
- Have you ever had a psychedelic or non-ordinary state experience? Have you written or spoken publicly on the topic before?
- Are you familiar with contraindicated medications and conditions for psychedelic substances? Do you offer medical screening for these?
- What are your session fees? Do you accept insurance or offer a sliding scale?
- How long do you normally see your clients?
Finding the Match
As you can imagine, many factors go into finding the right match between a client and a therapist. When considering psychedelic integration, additional factors specific to these non-ordinary states of experience (and how to make meaning of them) are especially relevant. Understanding a practitioner’s therapeutic approach and knowledge base around psychedelics can increase the likelihood of working with someone who can significantly help you through the integration process. Whether you are looking to solidify insights from your journey into your daily life, or seeking support after a difficult psychedelic experience, professional care or community integration groups are ways to gain deeper meaning from your experiences and assistance in navigating your life’s path. You are not alone, and with a bit of thoughtful effort, you will eventually find someone who can help you on your journey towards healing and transformation.