Psychedelic education is key to building an ecosystem of healing and disseminating best practices among health professionals. Join Allison Feduccia, PhD in an exploration of the current training and psychedelic education landscape, and what the future will hold.
Psychedelic education is on of the most important components to creating an effective and accessible system of healing. In light of the anticipated approval of psychedelic medicines, an educational ecosystem is required to share, collect and transmit knowledge, as well as support best practices to meet the projected need for competent health professionals.
Trained doctors, healthcare workers, therapists, and healers of all kinds are needed to deliver psychedelic medicines as they become approved, or to make referrals for their patients who wish to undergo legal psychedelic therapies. They will also need to be prepared for working with those who use psychedelics outside of the clinic. In addition to changing perspectives on medical use of psychedelics, Americans are seeing increased use of psychedelics in non-medical settings.
Need for Provider Training and Psychedelic Education
The psychedelic renaissance in medicine and mainstream culture necessitates expanding the education and training of health professionals. Misconceptions and myths about psychedelics are being replaced with evidence-based narratives, thanks to contemporary clinical trial findings. The level of education needed for health practitioners can be grouped into three main categories. Each category is based on how a practitioner will interface with patients who medicate with psychedelic compounds or use them for other reasons.
Training opportunities to become certified as a psychedelic therapist are quite limited at the moment. Pharmaceutical companies are developing protocols to administer psychedelics either as an adjunct to psychotherapy or with supportive care only. Researchers in clinical trials receive pharmaceutical company training (e.g. MAPS PBC, Usona Institute, COMPASS Pathways) to adhere to protocols for a specific drug and therapeutic approach. However, enrollment into these programs has mostly been restricted to those working on trials.
As of June 2021, 1400 clinicians have participated in MAPS’ MDMA Therapy Training Program. Anticipating FDA approval by 2024, MAPS plans to fully train and certify 3,000 therapists in time for the approval date. In order to treat 1 million patients by 2031, one report estimates 100,000 psychedelic therapists will be needed. When this goal is achieved, along with programs for widespread access, the United States mental health paradigm will be radically transformed.
Training programs outside of pharmaceutical companies and academic research settings are popping up. Here is a list of some available training programs:
- Integrative Psychiatry Institute (IPI)
- Polaris Insight Center
- Naropa University
- Sage Institute
- California Institute of Integral Studies (CTPR program)
- Psychedelic Research and Training Institute (PRATI)
Who Certifies Psychedelic Education and Training Programs?
At the moment, uncertainty surrounds who will issue accreditation and certifications for psychedelic training programs. Each program’s adequacy to meet the requirements set forth by drug sponsors and the FDA for approved psychedelic medications is still to be determined. The FDA has never regulated the practice of therapy or a drug-therapy combination like psychedelic-assisted psychotherapy. Though speculative, the FDA likely won’t say how training programs are administered, but will ask drug sponsors to assure their medication is delivered by competent providers.
New professional associations and accreditation boards are on a mission to establish new standards of care and standards of accreditation. It remains unclear how long-standing associations like the American Psychological Association and American Psychiatric Association will fit into the accreditation process, since they currently play a significant role in doing so for other postgraduate training programs. The costs of these new psychedelic-specific standards for patients and practitioners is also an open question.
Currently, health professionals are investing heavily by paying steep training program costs, anywhere from $1,000 to $15,000, without assurance that these certificates will be applicable for FDA-approved psychedelic medicines or meet the standards under development. At this time, there is no ketamine training accreditation, even though the drug is now widely prescribed off-label for mental health conditions. It’s simply up to the providers to determine what ketamine training, if any, is necessary to administer ketamine. With a drug as powerful as ketamine, the lack of requirements for training is alarming, and leads to varied and unpredictable quality of care.
Main Challenges to Establishing a Psychedelic Healthcare Workforce
In addition to these hurdles, the healthcare industry faces 3 main challenges to establishing sufficiently trained and educated providers: number of providers, certificate training programs, and continuing education.
- Number of Providers
Because psychedelic therapy is a novel modality that warrants a unique approach, the required number of trained providers to offer sufficient care will fail to meet demand at first. Almost everyone who finds themselves in this space will be new to it, with no prior experience. Thus, as new providers are trained up, demand will outstrip supply for a period of time. Eventually demand will be met with the proper amount of trained providers. This could cause difficulties in acquiring psychedelic therapy in rural or marginalized communities, who have less access to healthcare infrastructure.
- Certificate Training Programs in Psychedelic Education
Pharmaceutical sponsors, professional associations, and certification boards will outline qualifications and core competencies to qualify providers as proficient in delivering safe and effective psychedelic therapies. Most current psychedelic education programs require the candidate to be a licensed health professional or ordained clergy, and assume the trainee has already undergone extensive training in mental health and patient care. Programs are typically structured in multiple parts which may include: online eLearning modules, faculty lectures, role play, scenario enactments, breakout groups, experiential learning, instructor-led discussions, and supervision.
Psychedelic therapies come with special considerations related to the spiritual, transpersonal, and mystical nature of the experiences. Psychedelic experiences stretch beyond reductionist frameworks typically taught in medical fields, where all lessons are based on factual, empirical evidence and omit discussion around topics that can not be pinned down through the scientific method.
For example, mysticism, mysterium tremendum (awe-inspiring mystery) and psychedelic-induced sublimity can not be explained by current medical establishment frameworks. Our present era is one that’s seeing the irrational compete with the rational, and the psychedelic renaissance is just one such example. Making this adjustment in mindset may prove challenging for many.
Reading theoretical underpinnings and absorbing perspectives only goes so far. Only through an experiential exercise can one become intimately familiar with the bizarreness and ineffable quality of a psychedelic journey. Psychedelic training programs typically include an experiential learning component. The trainee enters into a non-ordinary state of consciousness to gain insight and first-hand knowledge.
MAPS offers trainees an opportunity to undergo MDMA-assisted psychotherapy in a clinical research study. If someone wishes to not participate for whatever reason, they can fulfill their experiential training through other activities such as Holotropic Breathwork, a legal ayahuasca retreat in a foreign country, or any other pre-approved altered state exploratory activity.
Whether or not experiential learning is necessary for training is a topic of debate. Psychiatrists don’t try all the drugs they prescribe to patients. On the other hand, you wouldn’t trust a sherpa to take you to the summit of Mount Everest who had never made the trek themselves.
In order to be a psychedelic guide, candidates will need to possess a set of core competencies. In a 2017 publication, Janis Phelps, the CIIS psychedelic therapy training program director, described six therapist competencies – empathetic abiding presence, trust enhancement, spiritual intelligence, knowledge of the physical and psychological effects of psychedelics, therapist self-awareness and ethical integrity, and proficiency in complementary techniques.
More specifically, we’d like to see all practitioners well-versed and skilled in these core competencies:
- Ethics of care
- Diversity, inclusion, and anti-racism practices
- Drug pharmacology
- Creating optimal settings
- Subjective effects
- Common adverse reactions
- Contraindicated medical conditions and medications
- Creating safety through preparation, informed consent, and warm settings
- Therapeutic approaches
- Supporting difficult experiences
- Working on a co-therapy team
- Clinical trial safety and efficacy findings
- Psychological mechanisms
To avoid harms and misconduct, psychedelic-assisted therapy providers must abide by strong ethical commitments and be held accountable. They must be informed about the unique issues that can arise during non-ordinary states of consciousness and receive extensive training and supervision to assure patient safety.
As psychedelics emerge in clinical practices, we must acknowledge and respect Indigenous communities’ long held reverence for psychedelic plant medicines in ceremonial and healing practices. Many Western medical professionals do not currently have the worldview to understand how adaptation of these long-held traditions can damage indigenous people or how to avoid cultural misappropriation and other harms. A delicate and nuanced balance is required to honor traditions while simultaneously advancing use of psychedelics to treat mental health conditions.
The majority of completed psychedelic clinical trials lack participant diversity in terms of race, ethnicity, sexual orientation, and socioeconomic status. As part of training, providers would benefit from well-rounded lessons in diversity and cultural sensitivity.
- Continuing Psychedelic Education
Like most medical specialties, the majority of health providers will not administer psychedelic therapies, but will need to be familiar with these approaches. They should acquire adequate information to discern between good versus poor candidates for psychedelic treatments. Continuing education (CE) and continuing medical education (CME) are the best avenues for professionals to learn the essential information to support patients through psychedelic therapy and the integration that follows.
To uphold serving the public, continuing medical education requires that the learning content be free from commercial influence and the bias of pharmaceutical companies. Third party education providers like Psychedelic Support adhere to these guidelines to safeguard learners and ensure they receive high quality, evidence-based psychedelic education information without interference from commercial interests.
After completing full training programs, continuing education will be required for psychedelic professionals to keep up with the rapidly evolving field. There are hundreds of novel studies already underway and being planned which could lead to the approval of many new psychedelic medicines. Research findings, together with information from clinical practices, will accumulate and be available for practitioners through courses, conferences, workshops, and clinical guidelines.
Professional networking will offer another viable avenue. As a more informal information exchange, professional networking events will provide a valuable opportunity to broaden one’s knowledge through conversations with other therapists, practitioners, and researchers.
Peer Support and Public Harm Reduction
In addition to licensed providers, other people and systems play a crucial role in weaving together support networks for people to stay safe and benefit from engaging with psychedelics. As individuals complete psychedelic-assisted protocols, long-term care and support can bolster the integration process. Community groups and integration coaches can be a more affordable option and accommodate a greater number of people. Psychedelic Support offers a directory of community groups for people seeking connection and support to assist with integration and mental health.
Not everyone enters altered states of consciousness through a facilitated session. These individuals may need support in processing challenging experiences or wish to integrate with others in their community who have undergone similar journeys. Family and friends can be a touchstone for individuals undergoing transformational experiences and represent an important layer in the tiers of care, especially if these loved ones have had previous psychedelic experiences.
Cultivate Care and Safety Together
As we can see, an entire ecosystem of health providers and community support systems are needed for the adoption and safe use of psychedelic medicines. By working together with all stakeholders, a thriving community will hopefully be borne out of a once fringe topic to bring world-wide healing and mental wellness. Education is the first critical step. Start learning today.