Anyone undergoing psychedelics psychotherapy is putting themselves at risk. They are surrendering to a power dynamic between themselves and the therapist in which they have little or no control.
They are in an altered state of mind, called a “non-ordinary state of consciousness,” usually lying down in a controlled environment, wearing a mask, vulnerable, trusting, with one or sometimes two trained therapist alongside them guiding and assisting their experience.
There is close-up discussion, touching, empathetic connections, and, with some psychedelics such as MDMA, sexual arousal of the patient. Psychedelic-assisted therapists are taught to use mindfulness-based modalities to present an attitude of non-judgmental and open curiosity to whatever the patient experiences.
They have to tread carefully. These are strong drugs. Psychedelics may function by dramatically reducing or shifting an individual’s defense mechanisms, according to one study. This can be useful for understanding both a patient’s distress during a psychedelic experience and their subsequent help with handling symptoms. But it can also leave the patient open for abuse.
There is alot going on in a psychedelics therapy session. Patients may idealize the therapist, or perceive the therapist as either a withholding gatekeeper of the psychedelic experience or as controlling their capacity to get better. Careful attention to what is going on with the patient, and how and when to adjust the patient/therapist interaction, is critical.
Training someone for that sort of personal intervention is different than the usual psychotherapist training. It’s new, it’s developing. And if done wrong, it can be problematic, perhaps even more so than traditional psychotherapy, causing irreparable harm.
For example, a 1991 national survey of 1,320 psychologists found that half the respondents reported assessing or treating at least one patient who had been sexually intimate with a prior therapist; a total of 958 sexual intimacy cases were reported. Most cases involved female patients; most involved intimacies prior to termination; and most involved harm to the patient. Harm occurred in at least 80 percent of the instances in which therapists engaged in sex with a patient after termination of the therapy.
But the quick buildup of psychedelics-assisted therapy, and the need for specific psychedelics therapists, in an unregulated area of psychology, means that almost anyone who wants to can be a psychedelics therapist.
One example: Oregon is working on details of its legalized psilocybin training program, including outlining qualifications for a licensed facilitator, who is the psilocybin experience guide. The facilitator doesn’t even need a college degree. Facilitator training does not have to come from the Oregon Health Authority (OHA); OHA just needs to be approve of the training program.
Another example: Psychedelics therapists don’t have to meet the same criteria for licensing as a psychologist in, say, California. To become a licensed psychologist in California requires a candidate to have a bachelor’s and master’s degree in psychology; a doctor of psychology or doctor of philosophy degree; pass two exams and go through some post doctoral experience; get 3,000 hours of professional experience supervised by a licensed psychologist; and go through various pre-licensure classes.
With the somewhat lax, and evolving, regulations and recommendations about psychedelic therapists, there are the inevitable bad apples.
In a 2021 study of the ethical challenges in psychedelic healing, 23 practitioners who administered MDMA and psilocybin to clients in underground (illegal) healing contexts were interviewed about their experiences navigating multiple relationships, nonsexual touch, and sexual boundary-setting in their work.
Of these practitioners, 12 had undergone formal, graduate-level training in psychotherapy. When interviewed for the study, some therapists highlighted that the lengthy sessions, coupled with the therapeutic use of touch, can lead to a level of intimacy not seen in classic talk therapy. The authors of the study said that many therapists felt that this intimacy is part of what is therapeutic about psychedelic work. But they noted that it has also led to ethical boundary challenges, often by inadvertently encouraging romantic feelings in the client.
The study concluded that psychedelic therapy is “rife with unique ethical challenges that require self-awareness and practical approaches that go beyond the training of a conventional psychologist.”
And so the ethical challenges have begun. Two examples:
– In a case of elderly abuse, a trained psychedelics psychotherapist allegedly worked with an elderly man in his 80s, who was in her charge, to manage his health conditions using ketamine. It is alleged that she took over his health care, had a romantic relationship with him, kept him taking ketamine, and managed to convince him to give her more than $4 million.
– In a clinical trial by the Multidisciplinary Association for Psychedelic Studies (MAPS), clinical trial participant Meaghan Buisson, who enrolled in a Phase 2 study of MDMA as treatment for PTSD in 2014, reported an “inappropriate and unethical sexual involvement” with her therapist after the active treatment session, according to a public statement about the incident on the MAPS website. At the end of 2015 or early 2016, the relationship between Richard Yensen, the co-therapist in the study, and the Buisson became sexual in nature. Donna Dryer, the other co-therapist and wife of Yensen, reportedly became aware of this and tried to stop the sexual relationship but was unsuccessful. She did not report it to MAPS or any regulatory agencies. Over time, Buisson grew uncomfortable with this relationship and eventually moved away in early 2017, breaking ties with both therapists. According to court documents filed November 28, 2018, Yensen “committed sexual assaults upon the Plaintiff which included but were not limited to having sexual intercourse with the Plaintiff, inappropriately touching the Plaintiff, inappropriately exposing himself to the Plaintiff, violating the Plaintiff s privacy, verbally commenting on sexual matters to the Plaintiff, making sexualized gestures, sounds and actions towards the Plaintiff, using inappropriate and sexualized language with the Plaintiff.” He also verbally abused Buisson, causing emotional and psychological harm, according to court documents.
Yensen was unlicensed to practice in Canada at the time, according to the court documents filed January 30, 2019. Yensen said the sexual relationship was consensual, and that Buisson initiated it in February, 2016.
MAPS’ legal counsel concluded that the therapists bore legal responsibility for their actions and that MAPS itself was not liable. MAPS agreed on a compassionate basis to pay $15,000 Canadian to Buisson so that she could afford to obtain therapy while her legal action against the therapists seeking compensation from them was still in process, according to the open letter on the MAPS website.
On Saturday, November 6, 2021, MAPS staff were interviewed by a reporter who had viewed videos of clinical trial therapy sessions with Buisson, and characterized Yensen’s behavior in at least one therapy session as “disturbing.” This characterization triggered a compliance review on Monday, November 8, 2021. That review is ongoing, but MAPS admitted that that Yensen and Dryer “substantially deviated from the MDMA-assisted Therapy Treatment Manual on several occasions during the treatment period.”
It’s clear that these sorts of abuses could continue unless the psychedelics industry takes proactive steps to address them with better training.
MAPS is a well-respected leader in psychedelics industry development. The organization has been working for better psychotherapist training since it established one of the first psychedelics psychotherapy training programs in 2012.
MAPS also recently sponsored the American Psychedelics Practitioners Association in November 2021 to address “the need for self-governance” in a rapidly evolving field, as a “national home for the diverse community of psychedelic practitioners.”
There are other organizations getting into psychedelic therapy training as well, including the Naropa University, a Buddhist-inspired university based in Boulder, Colorado, with a ten-month, 200-hour contemplative-based professional training program featuring a hybrid delivery of online and intensive retreat-based learning working in collaboration with MAPS; the California Institute of Integral Studies in San Francisco, accepting advanced professionals working in related therapeutic areas, such as licensed mental health clinicians, specific medical professionals, and ordained/commissioned clergy and chaplains; and Fluence, offering continuing education and certificate programs in psychedelic integration and psychedelic-assisted therapy, partnering with Beckley Psytech, a company working to develop clinically validated psychedelic medicines.
It is hoped that the specialized training for these new psychotherapists will become a standard part of the landscape of the emerging psychedelics industry. People seeking help for mental health issues need to trust their therapist, especially in the unusual and psychedelics-fueled power dynamic that exists between them, and the various psychedelics experiment design structures (low dose v. high dose, single dose v. multiple dose, etc.) that researchers are exploring.