From Underground to Mainstream: Preparing for the Surge in Demand for Skilled Therapists

From Underground to Mainstream: Preparing for the Surge in Demand for Skilled Therapists

By Arthur Lee

Arthur Lee is a friend of the Numinus team and a graduate of our Training program. He wanted to share his perspective on the Psychedelic movement and the community, at large. Although the content below is his opinion, we are honored to share voices from the experience of those who helped us reach this point in access. Numinus Training is for licensed and unlicensed individuals on traditional and alternative paths. Thank you, Arthur, for your contribution! 

Psychedelic-assisted therapy is poised to transform mental healthcare. Anyone who's been paying a modicum of attention to the mainstreaming and medicalization of the field knows this, and the science is clear. For most people, psychedelic medicines are safe, suitable, and vastly more effective for a myriad of diagnosable disorders than standard therapeutic approaches. With MDMA widely expected to clear the final FDA hurdle in the United States in August 2024, we are approaching a watershed moment. A once-outlawed psychedelic drug will become legally available in a medical setting. Rather than be compelled to navigate the "underground," unlicensed market or travel to another continent in order to access legal, well-supported psychedelic care. I may soon be able to receive psychedelic-assisted therapy with licensed providers within clinics across North America. Call me optimistic, but I firmly believe this is true: The psychedelic genie is out of the bottle, and there's no turning back. 


Reshaping Mental Health: Recalculating The Math Of Supporting Wellbeing

As psychedelic therapy becomes legally available, one of the most pressing questions becomes: How do we meet the imminent demand for psychedelic-assisted care with skilled and trained therapists? There are currently a few thousand therapists in North America alone who are accredited by training programs provided by MAPS, Numinus, and others, but how do we serve all those who may potentially qualify for psychedelic treatment? In the United States, it's estimated that approximately 12 million American adults experience PTSD in a given year. In Canada, about 5% of the population of 40 million have been diagnosed with PTSD. Do the math. We are not yet prepared to care for all those who may benefit from these treatments. Not even close. 

And that's considering MDMA-assisted therapy for PTSD alone. What about psilocybin for depression, end-of-life anxiety, and other indications? What about ketamine therapy training for Physicians instead of just for pain centers? What about 5-MeO-DMT for addiction? What about other psychedelic medicines that have not yet been created that we will discover and their potential therapeutic use? Take all those into account, and we have a massive shortfall of trained psychedelic therapists. Long story short: It's all hands on deck to get people the help they need as the legalization of psychedelic therapy takes place. 

"While many people may have safe and even sacred experiences in the company and care of friends or informal "trip sitters,"-- overlooking the necessity for trained psychedelic therapists threatens to put many users and clients at risk of harm."

A fair question that some are asking as we wonder how to meet the projected demand is if one necessarily needs formal training or certification to support others through altered states. Survey the average person who's ingested a psychedelic substance at least once in their life, and it is far more likely they did so in the company of friends than in the presence of a clinically-trained therapist or shamanically-trained facilitator. My first time ingesting psilocybin mushrooms was with my best friend, in an RV parked in the driveway of his grandparents' northern Ontario home. In the absence of a guide, we were still thoughtful and intentional about set, setting, and dose. That unsupervised psychedelic experience was one of the most meaningful moments of my young adult life. No therapist or guide was present—honestly, that didn’t even cross our minds. In my opinion, there will always be a place for the responsible, safe, and even recreational use of psychedelics. It is a fundamental human right to possess freedom of thought and choose how to modulate our consciousness in whatever informed setting we ultimately select. This is coming from someone who has both supported nearly a hundred people through their own psychedelic experiences through a clinically informed lens and consumed psychedelic medicines in open-air jungle huts in South America. 


The "When, Why, and How" of The Increased Demand

With all that in mind, the increasingly global, clinical application of these powerful substances requires a more rigorous and specialized approach. While many people may have safe and even sacred experiences in the company and care of friends or informal "trip sitters,"-- overlooking the necessity for trained psychedelic therapists threatens to put many users and clients at risk of harm. To suggest that all one needs to receive proper care and support through a psychedelic experience is someone they trust and who knows the terrain through personal experience is irresponsible and untrue. Both of those are absolute prerequisites for psychedelic facilitators, but they're not enough. Necessary but not sufficient. 


Thank you, Psychedelic Alpha, for permission to use your research; full interactive link here: 

While a trusted, knowledgeable companion can play an invaluable role in a person's psychedelic journey, the clinical application of these powerful medicines requires a level of training and expertise that goes far beyond informal peer support. Psychedelic-assisted therapy demands a comprehensive understanding of the pharmacology, neurobiological mechanisms, contraindications, and clinical evidence base for these substances. Practitioners must also be highly skilled in creating a safe, supportive, and therapeutically optimal setting, as well as guiding clients through the complex and emotionally charged experience. 


Effective psychedelic therapy also necessitates advanced therapeutic skills that go beyond just "being there" compassionately and without judgment for someone. Therapists must be adept at preparing clients, working with non-ordinary states of consciousness, navigating challenging emotional or psychological material that arises, having knowledge and skill working with transference and countertransference, and then skillfully assisting with integrating lessons and insights gleaned. This requires in-depth training in modalities like trauma-informed care, emotion-focused therapy, Internal Family Systems, Gestalt techniques, or other evidence-based approaches. 

Beyond the clinical expertise, psychedelic therapists must have also cultivated a high degree of self-awareness, emotional maturity, and comfort with the unknown. The psychedelic experience can open an intensely personal and profound process, and therapists must be willing to confront their own biases, wounds, and shadow elements in order to be fully present and effective. They must also be able to hold a steady, grounded, and compassionate space as journeyers explore the furthest reaches of their consciousness. Your buddy who’s tripped a dozen times may fulfill some but not all of these requirements. Even if nine times out of ten, sitting with an untrained guide doesn't result in a bad outcome for the client, it's that tenth vulnerable person that we must go to great lengths to protect. 

The Challenges Of Mainstreaming The Psychedelic Industry In 2024

If I sound a bit uptight about all this, it’s only because I have a profound respect and love for what these medicines can offer when approached responsibly. I’ve heard of too many accounts of people coming to great harm at the hands of unqualified “trip sitters” who were in over their heads and offering support outside of their scope of practice. People who were re-traumatized. People whose symptoms worsened. And yes, even people who took their own lives because of the inadequate support they received throughout the psychedelic process contributed to their destabilization. The mainstream adoption of psychedelic therapy has too much potential and promise for us to take any chances. We’re talking about providing the utmost level of care for people in extremely vulnerable states. The difference between a trained guide and another who isn’t could determine whether a person’s experience is healing or profoundly harmful, whether they find relief from their symptoms or are plunged even deeper into illness.  

"While the recreational and spiritual use of psychedelics will always have an important place and should be protected, the clinical application of these substances requires a level of skill, knowledge, and personal development that goes beyond informal peer support."

As psychedelic medicines become mainstream, it will be crucial to establish rigorous training and certification standards to protect the integrity of this emerging field of clinical psychedelic therapy. Regulatory bodies, professional associations, and pioneering psychedelic therapy organizations will all play a key role in developing these frameworks and ensuring that only the most qualified practitioners are entrusted with guiding people through these profound and potentially life-changing experiences in a clinical setting. While the recreational and spiritual use of psychedelics will always have an important place and should be protected, the clinical application of these substances requires a level of skill, knowledge, and personal development that goes beyond informal peer support. As we move into this new era of psychedelic-assisted therapy, we must uphold the highest standards of safety, ethics, and therapeutic excellence for those accessing these treatments through licensed medical providers.  

Numinus is leading the way in training competent providers to offer psychedelic-assisted therapy safely and effectively. They offer certification in ketamine, MDMA, and psilocybin, which are taught by highly experienced and actively practicing therapists who can give real-world guidance and support. Their pathways (subject to pending FDA approval) will also include valuable experiential learning opportunities and practicum placements to get first-hand experience with the medicines and to see real clients before certification. Their clear path to practice and highly credible curriculum will help ensure future providers offer safe and evidence-based care to clients in need worldwide. 

To get started, check out their Fundamentals of Psychedelic-Assisted Therapy program here: Fundamentals of Psychedelic-Assisted Therapy - Numinus.  

 The Fundamentals coursework is interactive, with opportunities to learn from professionals actively working in Psychedelic-Assisted Therapeutic (PAT) practices. There are live remote learning sessions with breakout rooms for peer-led learning and small group time with the mentors leading the courses. The training offers a balance of understanding the applications of PAT and personalized care for individual cases. It is perfect for those licensed and attempting to navigate their client’s needs after an altered state and those who work outside licensures and want to deepen their abilities to work with a wider variety of clients and treatments.  


What I want psychedelic-assisted therapy providers to know

What I Want Psychedelic-Assisted Providers to Know.


By Irene Borngraeber

Numinus wanted to share a personal story of healing from our community. Irene is one of our training participants and came to us with the desire to deepen her understanding of these medicines for her own development and to potentially help others navigate their own healing path. Numinus Training is for licensed and unlicensed individuals on traditional and alternative paths. Thank you, Irene, for sharing your story.

Two years ago, psilocybin changed my life. I came to the medicine out of desperation after surgical, holistic, and esoteric modalities failed to help me find a path forward through chronic pain and anxiety. I have a form of skeletal dysplasia (a malformation of all my joints), and I live with chronic pain and limited mobility that has worsened over time. The only corrective option was a joint replacement. Two years after I had both my hips replaced, I was still struggling to walk or move comfortably. My knees were buckling and slipping out of joint, and I did not feel like the left side of my body was “mine.” I couldn’t manage the stairs to do laundry or sit or stand comfortably. I was chronically on edge, literally trying to “grin and bear it,” clenching my jaw and grinding my teeth so hard they cracked.

Like many people who find plant medicine, I came as a last resort after the American medical system failed to help me live a life worth living. After my hip replacements, from an orthopedic standpoint, I was fine (or at least far better than I was before surgery). My joints were in the right place, and I was told I just needed to “give things time.” But I was not fine. I wanted to jump out of my skin: nothing could make me feel ok in my body. I could not relax; I could not sleep; I was trapped in a physical form that was painfully foreign and dysfunctional. Despite the efforts of well-meaning providers, the experiences I had with “traditional medicine” bored me, beat me down, and left me physically whole but unable to function: emotionally hopeless and spiritually dead.

"I could not relax; I could not sleep; I was trapped in a physical form that was painfully foreign and dysfunctional."

Psilocybin brought me back to life. It gave me back control of my body and allowed me to realize that although my physical pain had some very real roots, it was also a symptom of distress that ran much deeper. Psilocybin allowed me to remember how to heal and love myself. It reminded me how much I did not know about the universe.

I initially went to Mexico in order to access this healing. I took time off work and paid out of pocket because I had to find a way to heal. I write this knowing that it is not an option for many people struggling with physical limitations, severe health issues, and financial constraints. Although I am thrilled by the prospect of greater therapeutic access made possible through psychedelic legalization, I can’t help but marvel at just how structurally different these “healing” experiences have been for me. In one instance, I was alone in a hospital or therapist’s office, monitored and measured, and then billed by the hour after jumping through insurance hoops. In the other instance, I was staring at the jungle night sky in a circle of fellow travelers while a Shaman sang for hours on end to clean our spirits and guide us in soothing our souls.    

The American medical system made me feel like something broken to be “fixed”; Shamanistic traditions helped me find wholeness by empowering me to uncover and put together the pieces of my own puzzle. Psychedelics made me realize that I carry deep trauma and revealed just how desperate I had been —to not feel anything. My persistent denial of my own feelings was causing me to collapse physically; my body was screaming for help in the only way it knew how. It took this level of physical distress for me to realize how much emotional and spiritual healing I needed to move forward. I had to change my life. I had to figure out how to acknowledge and give voice to my pain to become whole.

Healing with psychedelics gave me back my autonomy and choice: two things I did not feel I had when subjecting myself to medical interventions from within the current healthcare system. Psychedelic healing is participatory. It works best when there is a mutual effort and, yes, surrender to the medicine and the feelings it brings forward. It’s uncomfortable. It’s messy. And it’s ultimately beautiful.

Since my first experience with psilocybin in Mexico, I have since become a student along this path and entered into what I imagine will be a lifelong process of learning from the plants. I have had many more medicine experiences, ranging from Western-centric science-based retreats to Indigenous ceremonies. While I initially felt more comfortable with a Westernized approach to psychedelic healing, my most profound evolution has come from Shamanistic practices.

Here are the top 5 personal lessons I’ve learned from Shamanism and how practitioners can approach and better understand them in order to empower their clients.

1. Denial Makes You Sick

In the Shamanistic worldview, dis-ease leads to disease. Our individual and collective repression, denial, anxiety, and mental/emotional discomfort build in our bodies and eventually emerge as physical illnesses. This is part of why people in the West are so “sick.” So many of us are constantly covering our feelings and discomfort with alcohol, food, exercise, shopping, and truly, any distraction we can get our hands on. These efforts are made to not feel the cosmic unrest simmering just below the surface.  We tell ourselves that we “should” be ok and have no “reason” to be unhappy. Eventually, the energy needed to maintain that delusion leaves us chronically depleted, just trying to survive. I’m not saying that physical illness and disease aren’t real or that they don’t have biological or genetic markers, but in Shamanism, these are all transmutable. By gently allowing the true source of your discomfort to become known to you and by looking at it with compassion, you can begin the process of releasing what has been poisoning you and start to become better. For me, acknowledging the roots of my chronic stress and anxiety started me on the path of being able to walk comfortably again.

2. Purging is Detoxing

In the West, we’re conditioned to see vomiting, diarrhea, sweating, and many other bodily functions as something to hide. We are used to unconsciously holding them in and attempting to self-regulate through mental control and physical tension or the use of pharmaceuticals (like anti-nausea medication). This is another symptom of chronic repression and stress, and something that is a barrier to initial psychedelic healing. In the Shamanistic worldview, these natural functions are the body’s way of detoxing the physical and spiritual energies that are making us sick, as well as drawing our attention to the fact that we have a need for more energetic cleansing. We need to allow them to happen, and that is not easy. Vomiting, specifically, is said to be good for the release of trauma, and many Shamanistic “dietas” begin by ingesting plants that make you vomit. Think of it as a radical form of letting go. It was scary, and for me, it was even difficult to figure out how to do it at first. My body was in a state of chronic, unconscious contraction that I needed to overcome. Once I was able to actually purge, I was also able to enter into the medicine more deeply and welcome the next stage of healing. I knew I was in good hands should anything get out of hand or if I was in medical distress, and I learned to lean in.

3. Trauma is Energy, and Disassociation is a Coping Mechanism

This was a big one for me. Despite being able to acknowledge I had traumatic experiences, I did not know I had trauma. I remembered everything; I could talk about everything, and I thought I was fine. I had no idea that what I called “anxiety” was actually called “panic attacks” by others and that my coping mechanism had been complete disassociation from my body and my feelings. What I did know was that I had pain. A lot of it. And when I was in ceremony that pain often got worse, building to intolerable levels. I would also get intense surges of energy, like seizures, that I could not control and simply had to allow to move through my body. I would often flop around my mat like a fish out of water. I did not have an explanation for this, but I felt I was desperately trying to rid my body of stagnant/negative energy. It was not until I began working with a very experienced Indigenous healer in Peru that I learned this twitching was known to him as trauma. That was the first time my experience was validated or explained in all of my ceremonies, and it was a huge relief. Trauma is energy. For some of us, it is purely physical. We cannot talk our way out of it; we cannot fully understand it, and often, somatic techniques are not enough to rid ourselves of it. Massage and hands-on techniques were crucial to my progression and the continued work of clearing out these stores of physical trauma.

4. Healing Requires an Undoing

Most of us construct our physical, mental, and emotional lives in order to avoid internal aspects of ourselves that are too difficult or too painful to face. We soothe our bodies and minds in any way we can, creating “safe” containers for us to live with this level of denial. I surrounded myself with work, responsibility, duty, and service to others in order to avoid my own deeply unmet needs. I couldn’t even name them. Daring to strip away these layers of coping, one by one, required me to take a hard look at how I had engineered my life in ways that were essentially not respectful or healthy for my true being. Many of those realizations were devastating. Healing involves significant periods of mourning and grief. For who we were, for how we damaged ourselves for the sake of keeping up appearances, and for all that we denied. It is hard, and it is lonely. I had to undo so many knots, one at a time, to have the opportunity to conceive of a different way forward. This is not a quick fix. It is not a panacea. It is an invitation to dare to change your existence for your own good.

5. Community is Crucial

We are ultimately responsible for our own healing, but that doesn’t mean we have to be alone. Shamanic medicine ceremonies are usually conducted with multiple participants, with opening and closing rituals that encourage openness and the sharing of experiences. Healing in community is powerful, and having the opportunity to bond with fellow seekers and trauma survivors has been one of the most validating experiences I’ve had along this path. I’ve seen how my words and physical experiences have impacted and inspired others, and hearing about their struggles and processes has made me feel stronger, more empowered, and so much less alone. Being honest, raw, and messy around other people who understood trauma allowed me to find my voice and speak my truth in a way I had not been able to before. It helped me own my pain and not be ashamed of my experiences or needs; it gave me perspective and enabled me to see how my story could help others as they walk along this difficult path. I’m so grateful to have been able to learn from these brave seekers, many of whom I’m still in contact with to this day. They are why I feel compelled to go out on this enormous "limb" and speak publicly about my own healing journey.

My own path of self-discovery continues, and building a community that supports this level of healing is increasingly important to me. We are not alone in this work. We are not broken. We simply need to find a better way to honor ourselves and our truths in this complicated world. I hope that medical practitioners will respect and learn from the Shamanic traditions that have kept this knowledge alive and learn into this wisdom-- for the good of their patients and for the good of the world.

Numinus is leading the way in balancing traditional and Western approaches to psychedelic-assisted therapy through psychedelic facilitator training. That starts with their thoughtfully curated education and training programs. Their approach is to weave cultural safety and cultural humility throughout their entire curriculum and offer wisdom from Indigenous voices on ways of knowing and providing healing to humanity. If you are looking to immerse yourself in this type of learning, I would check out their Fundamentals of PAT program. I look forward to learning and growing with Numinus and feel hopeful for the future of this work.

Irene Borngraeber is a recovering non-profit executive, student of the plants, and a companion to those seeking support along their healing journeys. Connect with Irene on LinkedIn.