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. 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, Cody, 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 provided nearly a hundred psychedelic experiences for others 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: https://psychedelicalpha.com/data/psychedelic-laws 

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.  

 

Episode 11: The Science of Personality & Philosophy of Well-Being with Professor Colin DeYoung

 

“I think that we can boil down well-being to two basic questions: How successful are

you in moving towards your goals? And how well integrated are your various goals?”

– Colin DeYoung

In this episode of the Numinus podcast, Dr. Joe speaks with professor Colin DeYoung. The purpose of the Numinus podcast is to inspire well-being: to help us all move toward a healthier, more joyful, and more meaningful life, for ourselves and our communities.

We are convinced that a scientific understanding of well-being provides a strong foundation for this pursuit and Colin is an exceptional guide to this area of science. Colin DeYoung is an Associate Professor in the Department of Psychology at the University of Minnesota. He specializes in the study of personality and its biological bases. He is well-known for his Cybernetic Big Five Theory, which provides a unifying theory for personality psychology and personality neuroscience. More info on Colin’s research can be found at deyoung.psych.umn.edu/.

This episode is particularly relevant at this time of the year – it’s the beginning of 2019 and for many of us, it is a period of reflection – a moment to clarify our hopes and dreams for the next 12 months. The podcast today should align nicely with this state of mind as Colin talks a fair bit about the philosophical bases of well-being science.

The conversation also addressed the impact of the following variables on well-being:

Colin and Joe speak about the Big 5 theory of personality and how it has surpassed the Myers Briggs approach to become the dominant model in personality science. If that discussion makes you curious about your own personality, you could get a report on your Big 5 profile by filling in a simple questionnaire: Big 5 Personality Inventory

Finally, if you are inspired to improve your well-being, Numinus could help. You could make an appointment with one of our therapists or coaches, you could register for one of our mindfulness programs, you could join our meditation community at Presence, or you could bring Numinus to your workplace.

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Here are some highlights of the conversation with Colin:

2:54 Who are you and what do you do?

3:32 How do you do this kind of research?

4:43 What about the fact that personality is sensitivity to context?

8:17 Are some people’s personalities more dependent on context than others?

11:05 Tell us about the Big 5 model of personality

17:54 How is the Big 5 different from the Myers-Briggs model?

25:01 How did you get into this kind of research?

 

28:50 What does the personality literature say about who experiences well-being and why?

So I guess a good place to start with this would be to talk about what do we mean when we say well-being? It turns out that philosophers and psychologists tend to come at this from pretty different perspectives.

Again, this is partly because of the challenges of measurement. We talked about the difficulty of how you measure people’s personality as well. It also turns out that it might be difficult to measure well-being depending on what you think well-being means.

If you think that well-being is simply of somebody’s satisfaction with their own lives and how happy they are, then it’s actually pretty easy to measure. So this is how psychologists understand well-being probably because precisely it is easy to measure.

In psychology what we do is just ask people how satisfied are they with their lives. How much positive relative to negative emotion do they experience. And some psychologists say that is a little too limited.

So now there is also a tendency to think about other types of well-being like how meaningful their lives are, whether people have a sense of purpose in their lives. Of course these are all very important things in terms of people’s experience of their own lives.

But nonetheless you’ll notice that they’re all still completely subjective. They’re just about how people feel about themselves consciously. So it turns out that most philosophers wouldn’t take that to be an adequate foundation for well-being. The school of philosophy that get closest to that view would be the hedonists.

So there are essentially three general types of theories about well-being and philosophy and I know about this under my tutelage from my friend Valerie. Hedonism essentially says that the balance is really what constitutes somebody’s well-being. You can talk about whether that’s important from the moment to moment or whether there’s some long run balance between pleasure and pain that we should have to establish somebody’s well being. But at any rate that is the only philosophical school that thinks subjective experience is the primary or crucial foundation for well-being.

There are two other general types of theory. One of them is known as list theories and the original one comes from Aristotle. So they are also referred to as Aristotelian approaches to well-being and they basically argue that there is some objective list of qualities that you have to achieve to have well-being. And that can be with the sense that you have to fulfill some kind of human nature. That you have live up to some potential for human nature and that is what true well being means. So if you have those kinds of things, whether they are–well, that’s the thing, different philosophers within this school will come up with slightly different lists of what are the qualities that a person should have like wisdom and temperance and good judgment or whatever else it is that once that somebody has that, you can say objectively that they have a high level of well being.

Then the third type of theory I usually call preference or satisfaction theories. And these basically state that people have certain desires, certain goals, and the degree to which they are actually achieving those goals or successfully meeting those desires is what really constitutes well-being.

There is obviously a subjective component there because what people’s goals and preferences are are going to be at least in part subjectively determined. But there is thought to be a real potentially objective question in many cases about whether people are actually moving towards their goals or not. In other words, somebody who was delusional, who thought things were going really well in their lives and had a strong sense of satisfaction and felt like their desires were being met even when if we can identify in truth that they weren’t. That they were failing in most of the things that they themselves profess as their goals and they’re heading to some kind of calamity, we might say that they’re actually be mislead or deluded about their own well-being.

Valerie’s theory is kind of a sophisticated version of a preference or desire satisfaction theory. It’s called Value Fulfillment Theory. It basically says that people have well-being to the extent that they are moving toward, fulfilling a set of values that they have. And those values have to be appropriate.

That’s the word that she uses. What that means is essentially is that people’s conscious judgments about what they want are well integrated with their emotional lives and basic motivations and these other things about themselves that may not be always fully conscious, but we can try to have some kind of insight into and to pay attention to.

It turns out that that idea that you have to have well integrated goals that are viable. In other words, they have to be realistically possible for you, that are sustainable, that are going to be things that work for you in the long term. Or at least notably long term because of course people can change their goals. And then also have this quality of being well integrated across our various different goals, both in our conscious and unconscious experience of the world or our relation to the world. That fits really well to the kind of approach I take to how personality works in which goals are really important.

 

35:57 What about Eudaimonic well-being – the notion that we experience the deepest well-being from the process of facing and overcoming adversity? How does that fit into your theory?

I do think it is important. People’s subjective sense of–we’re not claiming that people’s subjective sense of well-being whether it’s happiness or meaning or purpose is irrelevant. That’s obviously very important. But it’s just not the whole picture.

I think that in order to have a sense of purpose or meaning in life, you have to have what Valerie calls appropriate values. What that means is that you are motivated by some kind of larger, longer term goals.

I should probably say a bit about this contrast between values and goals. So I tend to use goals in a sense of the word that comes from a field called Cybernetics. We can talk a little bit more about it too because that’s the basis of my own personality theory. So Cybernetics is the study of systems that are goal directed and that manage to self-regulate via feedback. So they have some way of monitoring what the state of the world is and they also have some kind of representation about the way the world should be. And they are capable of comparing those things and then engaging in various kinds of strategies or actions or cognitive processes to try to transform the way that the world is into the way that they think the world should be.

And so these representations of the way that the world should be are goals. And goals can be as simple and straightforward as, ‘I want a sandwich because I’m hungry’ to something like, ‘I should always be an honest person’ or ‘I think that war is bad and that we should be trying to eliminate it from the world.’

What people often refer as values I think are in an important sense just some of these relatively broad abstract goals. That gives us a way of thinking about what it means for people to say that they have meaning or purpose in life.

 

41:36 What is the role of goals and values in well-being?

 

43:36 If well-being is so tied to goals and values, what do you make of the approach, exemplified by the secular mindfulness movement, that encourages letting go of the past and the future and appreciating what is already present?

I think that is a really great point. And I think that it’s actually compatible with the way that I think about well-being.

It actually raises some really interesting questions. I think that probably the right way to think about that–I think that we can boil down well-being from my perspective to two basic questions. One is how successful are you in moving towards your goals. And by that I’m not just including your concrete goals like getting a raise at work. I’m also including these much more abstract goals like being an honest person or kind or having fulfilling personal relationships. These kinds of things that people view as their ideal self or ideal future or the way the world to be.

And so the first key component are people actually making progress towards those things. And the second key component is how well integrated are their various goals? We can think about people’s goals as a hierarchy because some of our goals are broad and some of them are more narrow as we have already said.

And typically to achieve broad goals, there are subgoals, where some of those narrower goals that need to be met. Let’s say I am in college and let’s say I have the desire to have a fulfilling career and thinking about what my future is going to be, maybe I decide I have this feeling that I really want to help people. And so I think that, well, being a doctor would be a good way to do that. Suddenly I have this very broad goal. Which is to help people. Then I picked a somewhat more concrete subgoal. Which is to be a doctor.

So that’s a way in which I’m going to be able to help people. And that subgoal of being a doctor itself needs a whole bunch of different subgoals. So that means I have to successfully get into medical school. That means I need to take pre-med. There are sorts of things that one has to do in order to achieve these broad long term goals and they too are narrower goals.

So we have this whole complex set of goals and the problem is that they don’t all necessarily fit in together with each other very well. Let’s imagine this person who wants to be a doctor and let’s imagine that they always really enjoyed music. Let’s say they’re an excellent musician, studied music as a child, really enjoyed it. But now they feel like that music is good, but I’ll keep doing that on the side. I got to get into med school and be a doctor, so maybe I don’t have as much as time for it as I used to. Now that might work out. Maybe for this person music works fine as a side hobby. But maybe it turns out that they a lot more attached to making music than they realized.

What they’re finding is that they’re not enjoying organic chemistry or these various other things that they’re taking in order to be a doctor. There is essentially no time for music. These classes are hard. That’s out the window. They really start to suffer because of that. Because they feel there’s a detriment to their well-being.

And now there’s an interesting choice to make. And sometimes people make these choices without consciously realizing that they’re doing it. It’s like things just drop off or conflicts between different goals that people have, people make compromises. Sometimes without even paying attention to the fact that they’re making compromises. So a lot of what we have to deal with in life, and a lot of what leads to poorer quality of life or lack of well-being has to do with goal conflict.

We have some need that is not being met because a need is just another way to talk about a goal. To me a need is basically like a goal that is built into the human being by evolution. There are certain goals that are not optional for most people. You can’t escape them. And so there are often these tensions between fulfilling our different needs or goals or values.

And I think, if I can bring this back around to where your question started out, that these traditions that emphasize the importance of mindfulness and non-judgment and letting go of our attachments, what they’re doing is basically providing us a tool with figuring out what are really our important goals. Like they don’t usually use those words.

That’s partly because I’m using goals in a more general and abstract way. But you might think that they help us figure out what our important values are. What do we need to be attached to? What do we not need to be attached to?

Now you might say, ‘hang on, hang on. If you’re going to be a good Buddhist, you don’t need to be attached to anything. You have to have complete non-attachment.’ But interestingly I think that’s like one of the things we were talking about earlier like one of these values that maybe works for some people to work toward, but is not actually something that you can achieve. You cannot cease to be a Cybernetic system.

n other words, you cannot cease to be an organism and organisms are goal directed by their very nature. That is essentially what makes an organism what it is. You will continue to need to eat and to sleep. You will continue to care about your interpersonal relationships. You will continue to have goals, no matter how good of a Buddhist you are.

 

50:03 Do you think it’s possible to achieve freedom from our attachments?

 

56:57 How is your meditation practice these days? Does your experience with meditation align with your theory of well-being?

I wish I could say that I have a good meditation practice still. But the fact is that at this point I am meditating only very rarely. And it would be great if I were doing it more.

I thought about why it’s hard to maintain meditation practices. I think that if I look back over my life for the last let’s say almost 20 years, at least 15, when I took that class with you, and that’s when I really started meditating.

What I got out of that–and I had a very regular meditation practice for probably about 5 years let’s say. That was hugely important for my development. And for what I would say is my well-being even through to today. And a lot of what I learned with that practice still influences the way I experience life all of the time even though I don’t sit very often anymore.

So what happened was that there was a period of a few years where I was meditating less often, and since then it’s kind of dropped off. I always thought about it a lot. Even when I was meditating often, I was having a hard time making the time to sit and meditate and that was weird to me as a psychologist because of the fact that when I did, I found it so rewarding.

Some people talk about really struggling and of course everyone if they have had a really regular meditation practice has had the experience of really struggling with their practice and feeling like that sometimes the mind wandering is worse than usual and it can get frustrating.

I didn’t have that experience too often. I certainly have had plenty of experience of having an unruly monkey mind. I generally thought it to be a really positive experience in the moment while I was sitting there, like it was emotionally positive for me.

And so then like a good psychologist I thought that this should be conditioning me. this should be making it really to be motivated to do this. And I started to think about why that might be.

When I started to learn about some of the ways that the brain’s reward system works and in the way that dopamine works and the way that the endogenous opioid system works, I kind of developed a hypothesis–I haven’t tried to test it yet–about why that might be the case.

Basically what you’re doing when you’re meditating is that you’re trying to free yourself from desires, from trying to pursue things, from being judgmental about things, from being caught up with a certain goal, whatever it is. So I think one of the things that you’re doing in typical meditation is that you are really trying to turn off the dopamine system. Give yourself some freedom from wanting things in order to have this greater clarity and perspective.

Out there in the popular press, dopamine gets presented sometimes as a feel good chemical as what makes you happy. That’s not true. If you take a dopaminergic drug, it will often induce euphoria and that’s why people like cocaine and amphetamines which are acting directly on the dopamine system. But it turns out that that feeling of pleasure is actually due to a different set of neurotransmitters those that are related to the opiate system.

But what dopamine is doing is making you motivated. It’s making you want things. It’s really more a chemical about wanting than it is about liking things. I think that what you’re doing when you meditate is that you are temporarily trying to deactivate your dopamine system.

And the interesting thing about that is that dopamine creates learned motivation. I think that’s what is happening, one of the reasons why it’s hard to maintain a meditation practice. Even though you kind of have the liking and enjoyment of the behaviour, but you are intentionally suppressing the process that would normally make the behaviour addictive, that you were really motivated to do, and that you had the desire to do in a way that manifested in your behaviour.

So I think that there is something interesting about the way that meditation works by its very nature that makes it inherently harder to train yourself into a habit with it.

That would really explain a lot if it is true because this is something we face at Numinus. And everywhere I go trying to inspire people to meditate, almost everybody recognizes that it would be beneficial and valuable and a useful thing to do. But it’s just so hard to make it stick.

One of the things that for probably millennia people have understood about maintaining a meditation practice is that community is a hugely important component. There’s the Sangha and there are the people you sit with and I wonder if it’s a question of reward of introducing reward into the routine. I think it’s not even just reward.

Although of course people are rewarded by social engagement often in community. But it’s also just building a pragmatic structure, so that you have the organization. And it’s not just up to you and your whims whether you pursue the practice or not. You have obligations to other people. You got all these other motivational systems that are now coming into play that help you organize your behaviour, other than just whether you feel like doing something or not.

 

1:05:17 How does personality fit into your well-being theory. Do our personalities lock us in to a pre-disposed level of well-being?

1:10:02 What are “characteristic adaptations”?

1:12:35 What are the best tools for changing “characteristic adaptations” to improve well-being? What are the obstacles?