Developing Guidelines and Competencies for the Training of Psychedelic Therapists
Journal of Humanistic Psychology, 2017, 1–38
Research since the 1950s has shown that psychedelic-assisted psychotherapy has had significant positive effects in reductions of specific clinical symptoms and increases in quality of life as measured on a variety of indices. The intensity of focus on evidence-based outcomes, however, has resulted in a paucity of active discussions and research on the core competencies of the therapists themselves. The context of the history of psychedelic research reveals how this neglect of therapist variables occurred. With current discussions of Phase 3 and expanded access research programs for psilocybin-assisted and MDMA-assisted psychotherapies, there will be a great need for competent therapists trained in this clinical specialty. This is particularly the case if less restricted, legal medical use is approved within the next 6 to 10 years. This article is the first review and compilation of psychedelic therapist competencies derived from the psychedelic literature. These six therapist competencies are 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. A further contribution of this review is a delineation of the 12 fundamental curricular domains of study for the training and development of these therapist competencies. As current legal restrictions evolve, aspects of these training guidelines will develop accordingly.
Keywords : psychedelic, therapist, competencies, psychedelic-assisted, training, guide, therapy, ethics, presence, set and setting, empathy
Setting the Stage for Psychedelic Research
The evolution of psychedelic psychotherapy in the 20th and into the 21st century has been both furthered and stymied by the cultural backdrop against which these substances were being explored at the time. When research into psychedelics, known collectively as hallucinogens, was underway in the early 1950s in clinical and laboratory settings, they were viewed as tools that could be used to better understand how the brain itself works (Abramson, 1960; Grob, Greer, & Mangini, 1998). From 1950 to the mid-1960s, there were more than 1,000 clinical papers published about the sessions of some 40,000 patients, scores of books and six international conferences on psychedelic-assisted psychotherapy (Grinspoon & Bakalar, 1979). A core question underlying psychedelic-assisted therapy surfaced in those early years, well stated here by conference panelist, Robert Murphy : “Is LSD [lysergic acid diethylamide] a therapy in itself, with the therapeutic relationship functioning merely for support? I believe this is so. Or is the essential therapeutic process the sort of thing Dr. Abramson described, in which the therapeutic relationship is the essence of the therapy, and LSD simply facilitates or catalyzes it? These questions underlie a good deal of the discussion here, and are perhaps of more importance than we have recognized.”
(Lennard & Hewitt, 1960, p. 219)
There are references in the research literature to the hypothesized effects of therapist competencies and therapeutic alliance-building on clinical outcomes, but these variables have gone relatively un-systematized and un-researched due to changes in the political climate in the United States. Any discussion of therapist skill bases and the training of therapists for this research requires a historical contextualization within the ebb and flow of the 60-year-old psychedelic research field itself.
In the clinical setting, these substances were initially of interest based on a belief that they could induce elements of psychosis (an effect often termed psychotomimetic) and could reveal underlying psychodynamic processes (Eisner & Cohen, 1958; Grob, Bossis, & Griffiths, 2013). However, soon interest shifted to their potential as catalysts for therapeutic healing in the clinical setting, particularly with the classic psychedelics, mescaline, and LSD (lysergic acid diethylamide). In a therapeutic model known as psycholytic therapy, low- and mid-dose applications were administered over an extended period of time in conjunction with psychoanalytic psychotherapy (Grof, 1968; Naranjo, 2013; Passie, 2012). Alternatively, high-dose applications were used and limited to a handful of significantly longer sessions followed by psychotherapeutic integration work (Gasser et al., 2014; Osmond, 1957).
During this cornucopia of research, some clinicians posed optimal qualities for therapists. Early researchers suggested that therapists should have a mix of empathy and “objectivity,” which they variously defined as “being as normal as possible” and “balanced” (Lennard & Hewitt, 1960). Others remarked that therapists needed to be calm and composed (Blewett & Chwelos, 1959), aware of the effects of their reactions on the research participant (Buckman, 1967), and keenly capable of transference analysis (Hoffer & Osmond, 1967). While direct research on therapist variables was proposed during this period, there exist only clinical case studies and self-reported, anecdotal, and sparse discussion of qualities, skills, and competencies for therapists.
Researchers in the 1950s and 1960s who pursued psychedelic-assisted therapy quickly discovered psychedelics’ mysticomimetic potential—their ability to catalyze transformative, breakthrough experiences (Abramson, 1960; Eisner & Cohen, 1958; Riedlinger & Riedlinger, 1994). The promise of psychedelic-assisted therapy was considered so great that psychiatrists and psychologists began convening conferences where researchers could share their findings and discuss the potential implications of them. For example, international conferences on the use of LSD in psychotherapy were held in Princeton, NJ, London, and Long Island, NY, in 1959, 1961, and 1965, respectively (Pahnke & Richards, 1966). In April of 1969, the American Association for Humanistic Psychology and the Menninger Foundation cosponsored an invitation-only conference in Council Grove, Kansas, dedicated to the topic of altered states of consciousness, which counted among its participants “national and international therapists working with psychedelics” (Fadiman, 1969, p. 135).