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

By Arthur Lee

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 a 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.