Experiential Training in Psychedelic-Assisted Therapy: A Risk-Benefit Analysis.
bioethics
education
experiential training
psychedelic‐assisted therapy
risk‐benefit analysis
Journal
The Hastings Center report
ISSN: 1552-146X
Titre abrégé: Hastings Cent Rep
Pays: United States
ID NLM: 0410447
Informations de publication
Date de publication:
Jul 2024
Jul 2024
Historique:
medline:
8
8
2024
pubmed:
8
8
2024
entrez:
8
8
2024
Statut:
ppublish
Résumé
Well-trained, competent therapists are crucial for safe and effective psychedelic-assisted therapy (PAT). The question whether PAT training programs should require aspiring therapists to undergo their own PAT-commonly referred to as "experiential training"-has received much attention within the field. In this article, we analyze the potential benefits of experiential training in PAT by applying the framework developed by Rolf Sandell et al. concerning the functions of any training therapy (the therapeutic, modeling, empathic, persuasive, and theoretical functions). We then explore six key domains in which risks could arise through mandatory experiential training: physical and psychological risks; negative impact on therapeutic skill; justice, equity, diversity, and inclusion; dual relationships; privacy and confidentiality; and undue pressure. Ultimately, we argue that experiential training in PAT should not be mandatory. Because many PAT training programs already incorporate experiential training methods, our exploration of potential harms and benefits may be used to generate comprehensive risk-mitigation strategies.
Substances chimiques
Hallucinogens
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32-46Subventions
Organisme : Dana Foundation
Informations de copyright
© 2024 The Hastings Center.
Références
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We acknowledge that the term “patients” is contested within the field of mental health and perhaps more so in the field of PAT, given the long history of nonmedicalized uses of psychedelics—even in contexts where the psychedelic is considered “medicine” or is used as part of “healing” practices. We use the term “patients” here deliberately, given the position from which we are writing, that is, from that of clinicians, researchers, and ethicists in the medicalized field of PAT. We also use the term “clients” interchangeably, given the common use of this term in the field of psychotherapy.
“Classic psychedelics” are generally defined by their shared pharmacologic activity at the 5HT2A receptor and include psilocybin, lysergic acid diethylamide (LSD), mescaline, and others. Drugs with different pharmacologic properties, including MDMA and ketamine, can produce similar subjective states at appropriate doses and under suitable conditions. We use the term “psychedelic” throughout to refer to those drugs that are currently being studied under the medicalized PAT paradigm, chiefly psilocybin and MDMA.
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The historical opinions summarized by these authors generally do not specify under what contexts therapists and researchers may have their own psychedelic experiences. While our exploration centers on the benefits and risks of psychedelic therapy as a component of training in the field of PAT (i.e., as opposed to having lived experiences of taking psychedelics outside of a training context), we believe that there is epistemic value in lived experience broadly construed.
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Moe and Thimm, “Personal Therapy and the Personal Therapist”; S. Macran and D. A. Shapiro, “The Role of Personal Therapy for Therapists: A Review,” British Journal of Medical Psychology 71, no. 1 (1998): 13–25.
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See, for example, G. S. Danzer, Therapist Self-Disclosure: An Evidence-Based Guide for Practitioners, 1st ed. (Boca Raton, FL: Routledge, 2018).
D. Collins et al., “‘If It Wasn't for Him, I Wouldn't Have Talked to Them’: Qualitative Study of Addiction Peer Mentorship in the Hospital,” Journal of General Internal Medicine 34 (2019): 1–8; D. Eddie et al., “Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching,” Frontiers in Psychology 10 (2019): doi:10.3389/fpsyg.2019.01052; L. Francia et al., “‘The Peer Workers, They Get It’—How Lived Experience Expertise Strengthens Therapeutic Alliances and Alcohol and Other Drug Treatment-Seeking in the Hospital Setting,” Addiction Research & Theory 31, no. 2 (2023): 106-13. Not all kinds of lived experience are the same; completing an experiential training program would not provide someone with the credibility of lived experience of psychedelic use in the same way that a peer worker may have credibility as they draw upon their substance use or mental health experiences as a form of lived expertise.
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J. D. Frank and J. B. Frank, Persuasion and Healing: A Comparative Study of Psychotherapy (Baltimore, MD: Johns Hopkins University Press, 1991). For a broader application of common factors theory to PAT, see N. Gukasyan and S. M. Nayak, “Psychedelics, Placebo Effects, and Set and Setting: Insights from Common Factors Theory of Psychotherapy,” Transcultural Psychiatry 59, no. 5 (2022): 652-64.
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“Drug Product Announcements,” Health Canada, date modified May 24, 2024, https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements.html; Johnson, Richards, and Griffiths, “Human Hallucinogen Research: Guidelines for Safety”; American Psychedelic Practitioners Association and BrainFutures, Professional Practice Guidelines for Psychedelic-Assisted Therapy.
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Danzer, Therapist Self-Disclosure.
T. I. Michaels et al., “Inclusion of People of Color in Psychedelic-Assisted Psychotherapy: A Review of the Literature,” BMC Psychiatry 18, no. 1 (2018): doi:10.1186/s12888-018-1824-6.
J. Thrul and A. Garcia-Romeu, “Whitewashing Psychedelics: Racial Equity in the Emerging Field of Psychedelic-Assisted Mental Health Research and Treatment,” Drugs: Education, Prevention & Policy 28, no. 3 (2021): 211–14.
Michaels et al., “Inclusion of People of Color in Psychedelic-Assisted Psychotherapy.”
Earleywine et al., “How Important Is a Guide Who Has Taken Psilocybin in Psilocybin-Assisted Therapy for Depression?”
B. McCarthy, “Christianity and Psychedelic Medicine: A Pastoral Approach,” Christian Bioethics 29, no. 1 (2023): 31–57.
College of Psychologists of Ontario, “Professional Boundaries in Health-Care Relationships,” accessed August 10, 2023, https://cpo.on.ca/wp-content/uploads/Professional-Boundaries-in-Health-Care-Relationships.pdf.
Ibid.
College of Registered Psychotherapists of Ontario, “Professional Practice Standards,” unedited, unformatted version, 2023, accessed August 10, 2023, https://www.crpo.ca/wp-content/uploads/2023/12/CRPO-Professional-Practice-Standards-Jan124-Unedited.pdf.
College of Psychologists of Ontario, “Professional Boundaries in Health-Care Relationships.”
Emmerich and Humphries, “Is the Requirement for First-Person Experience of Psychedelic Drugs a Justified Component of a Psychedelic Therapist's Training?”
See, for reference, Grof and Grof, Holotropic Breathwork.