Psychedelic Therapist Training: The Fundamentals

By Julian Bost

So, you’re thinking about becoming a psychedelic therapist? Numinus' goal is to pave the path to certification for folks interested in this profound healing modality. We offer a range of courses to help fully prepare you for work and experiences in this field. Our Fundamentals of Psychedelic-Assisted Therapy course is the first step. Collaborating with the folks over at Healing Maps, we created this blog series to provide both scientific rigour and practical insights into the training journey of a psychedelic-therapist. Whether you're a therapist looking to expand your skillset, or someone curious about the intricacies of this therapeutic field, you're in the right place.

 

The Emergence of Psychedelic Therapy

The undeniable potential of psychedelics, from MDMA's effectiveness in treating severe PTSD to psilocybin's impact on major depression, signals a profound shift. The word 'psychedelics' now echoes in coffee shops, office corridors, and even the National Football League. This cultural shift is evident when highly public figures like Aaron Rodgers discuss their ayahuasca use without repercussions.

 

On a larger scale, philanthropists and institutions are actively backing psychedelic research. The CEO of TOMS pledged $100 million to this cause, while venerable, longstanding institutions like Johns Hopkins University are conducting groundbreaking studies on the link between psychedelics and consciousness. On a global scale, Australia became the first country to legalize MDMA and psilocybin for prescription use.

 

Psychedelics have entered our culture through various avenues, from microdosing to shamanic retreats. However, the most regulated and standardized path may be through therapy. Over the last seven decades, psychedelic-assisted therapy has proven both safe and effective in Europe and North America, with Numinus being at the forefront of today’s movement. As psychedelics gain more approvals globally, the demand for mental healthcare professionals trained in this therapy is set to surge.

 

The Questions That Arise

The growing prominence of psychedelic-assisted therapy prompts crucial questions: How can one become a psychedelic therapist? What is the path, and what does it entail to step into the realm of psychedelic therapy?

 

In being a psychedelic therapist, your job will combine two key elements: The use of a psychedelic substance (such as psilocybin, ketamine, MDMA, etc.) coupled with traditional psychotherapeutic practices. 

 

It's important to note a couple of critical points. Without the therapeutic component, psychedelic use is often considered “recreational.” While recreational or “underground" use has its place, psychedelic therapy is deemed particularly effective due to its professionalism, safety, and therapeutic integration components.

 

The Role of a Psychedelic Therapist 

 

The role of a psychedelic therapist varies based on location but generally requires being a licensed mental healthcare professional. This includes clinical psychologists, psychiatrists, clinical social workers, registered nurses, nurse practitioners, and chaplains who have received specialized training in psychedelic therapy. In essence, a psychedelic therapist is a licensed mental health professional equipped to combine psychotherapeutic practices with guided psychedelic experiences, unlocking individuals' innate healing potential.

 

How to Get Involved

The future holds significant demand for certified psychedelic therapists, and you could be one of them. Explore Numinus' Certification Pathway for more information. As this field continues to evolve, it is vital to ensure our knowledge is rooted in evidence and thoughtful consideration. 

 

Stay tuned for our next article, where we will explore the global legal landscape of psychedelic therapy.

 

The Impact of Psychedelic Harm Reduction In Therapy

3 Benefits of Using a Harm Reduction Framework in Your Therapy Practice

According to a recent study by the National Institute of Health, psychedelic use is on the rise. The percentages of young people who said they used hallucinogens in the past year had been fairly consistent for the past few decades, until 2020 when rates of use began spiking. In 2021, 8% of young adults said they have used a psychedelic drug in the past year, the highest proportion since the survey began in 1988. Reported hallucinogens included LSD, mescaline, peyote, shrooms, PCP and MDMA (aka molly or ecstasy).

With this increase in recreational psychedelic use, there is a growing need for mental health professionals to expand their practices to support harm reduction and psychedelic integration needs. Here are the top 3 reasons practitioners should adopt a harm reduction framework in their therapy practice.

 

1. Builds Trust & Rapport With Clients

By maintaining a non-judgemental, accepting, compassionate, curious, and positive stance when exploring a client’s substance use, as well as other risky or harmful behaviours, you are directly contributing to the trust that client has with you. Being open and curious signals to the client that they are safe to walk through their thought process and current decision-making around psychedelic use, where you can gently advise on any dangers and practices they should take into consideration. When supported in this way, these clients are more likely to stay with you long-term and if you decide to provide psychedelic-assisted therapy in the future, they may feel comfortable turning towards psychedelic care provided by you. 

 

2. Helps Clients To Make Informed Decisions

When psychedelic medicines are used outside of clinical settings, proper education, preparation, and support can mitigate potential harms and increase the likelihood of clients having productive experiences (Gorman et al., 2021).  

Particularly with the medicines used in psychedelic-assisted therapy, clients may start treatment with some inaccurate information about the psychedelic medicine being used. The internet (particularly social media platforms) is full of misinformation about psychedelic medicines, their effects, adverse effects, and anticipated experiences. 

When a client has a more fulsome understanding of experiences and the decisions associated, potential benefits and harms are affected in ways that can enhance and protect their experiences, further contributing to trust this client has with you. 

 

3. Presents A Unique Opportunity To Work With Your Clients

When discussing psychedelic use, an important role you can play with your clients is to help with the integration work. Working on integration is your opportunity to keep the positive changes engendered by psychedelic experiences alive. In this regard, good integration work with your clients will help facilitate lasting changes and could reduce the need for ingesting medicines recreationally outside of a clinical setting. Not only is this an opportunity to work more with your client, but it’s a unique opportunity to really dive into positive and meaningful changes that are important to your client, which can facilitate deeper connection and meaning making as part of your regular appointments. 

 

In Conclusion: 

“Using a harm reduction framework in your clinical practice allows you to support your clients with non-judgmental, compassionate, and acceptance-oriented care. We should expect that clients may choose to use substances outside of the clinical setting, and that providers can play an important role in mitigating any harms associated with that, through building trust and rapport. We teach a harm reduction framework in our Psychedelic-Harm Reduction and Integration course at Numinus, which includes transparent discussions around the legal and ethical responsibilities in doing this work. Psychedelic use is going to continue to rise as more folks seek the healing potential of these medicines, so education in this area is going to become increasingly important.” 

- Amanda Giesler, Director of Training

 

Learn More: 

Join us for a 2-day introductory workshop on the practice of Psychedelic Harm Reduction and Integration (PHRI) and learn the tools needed for educating clients about altered states of consciousness and how to integrate these experiences. Click here to learn more.

 

*The continuing professional development program in no way promotes, condones, or facilitates illegal activity, and is strictly for educational and harm reduction purposes only. Please be aware that certain psychedelic substances still remain illegal in many jurisdictions, including Canada. This program and the contents of this website do not constitute medical advice, and are not a substitute for professional medical advice and treatment.

MAPS Examining the Psychedelic Renaissance - Season 2 Episode 10 with Drs. Reid Robison & Adele Lafrance

Episode 10: Psychedelic-Assisted Psychotherapy for Eating Disorders and Cognitive Behavioural Therapies for PTSD + MDMA

Episode Summary: Hear from the MAPS Researchers. In this episode we will get to hear from some of the leading experts in the field of clinical psychedelic research. Both Dr. Adele Lafrance and Dr. Reid Robison are currently focussed on a study looking at using MDMA to treat PTSD. While Dr. Anne Wagner also has a background investigating Eating Disorders, she will be touching on her work with MDMA + Cognitive Processing Therapy.

Exclusive Post Webinar Sessions:    (Exclusive Post-Webinar Session Details:  Session take place in a private zoom room with the speaker and 6-10 other participants. Limited Capacity. Zoom links sent out the day of the event.  6:30-7:30PM PST, Tuesdays (following the speaker’s episode).  Webinar attendance is not mandatory; however all passes include 1 complimentary ticket to the entire series! 

  • Join Adele and Reid for an Exclusive Q&A. Reid is currently the coordinating investigator for the MAPS-sponsored study MDMA assisted psychotherapy study of eating disorders, and Adele is the clinical investigator and strategy lead for the MAPS-sponsored MDMA-assisted psychotherapy study for eating disorders. This is your chance to meet with the two of them and have all of your questions answered in a semi-private session. To register, see Ep 10Ex: Exclusive w/ Adele & Reid.

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Why Is Therapeutic Integration Important?

Now What?
Picture this: you’ve just had your first ketamine session. It went much better than you planned. You felt uncomfortable at first, but after settling into the experience, you entered a dream-like, euphoric state. As soothing music played in your headphones, you felt your mind disconnecting from your body. All the stuck emotions finally began to unravel themselves.

Now you’re waiting for your ride home. Questions swirl in your head as you begin to think back on what you saw and felt during the ketamine experience. You think about the memories that replayed, odd memories you tried not to think about for years.

At this point, you might be wondering, “Now what?” or “How was that experience productive?” You might even find yourself distressed and burdened by the reintroduction of new ideas and feelings that are uncomfortable and difficult to process.

Therapeutic Integration
This is where therapeutic integration comes in. “It is not often easy for our rational minds to make sense of a psychedelic experience,” says Hannah Cross, one of our Licensed Clinical Social Workers in Utah.

While the ketamine experience has the power to create lasting change, much of the “transforming” is up to you. Working with a trained therapist, therapeutic integration helps you discover actionable insights that can turn an interesting ketamine experience into a transformational one.

“Integration is how one bridges the experience (often associated with transcendence of time and rational thinking) to life outside of the experience. The psychedelic journey doesn’t actually start or end when the medicine’s psychedelic effects start and end.”

Psychedelic Integration Group
At Numinus, we offer a monthly virtual psychedelic integration group. This group utilizes components of various therapy modalities to help clients turn their psychedelic experiences into meaningful change in their lives.

While group therapy might seem intimidating at first, Hannah explains, “Group therapy can provide a powerful opportunity for individuals to connect with others, even those from different backgrounds.

According to Hannah, “this online community is “a game-changer,” especially, “[during] a time [when] many people have felt quite isolated over the last couple of years.”

Of her recent group participants, Hannah says that some have pursued additional work with an individual therapist, while some have built supportive friendships from their connections in the group. In one case, [a] previous participant decided to integrate his psychedelic experiences by outfitting his van and embarking on a cross-country, solo road trip!”

Session Format
The group integration sessions follow a similar pattern. After participants introduce themselves, they discuss their intentions and any examples of integration they found useful, Hannah then proposes a discussion based on a topic related to psychedelic integration.

“A discussion...may follow,” Hannah says, “but more often, there is a guided, more experiential process facilitated by the therapist.” The session is then concluded with discussions in small, 2-3 person break out groups.

This digital first approach to group therapy has been a game changer: “All of this can be done through Zoom and I haven’t found the online platform to jeopardize the effectiveness of the group, at all.”

“In fact, a virtual group has allowed individuals who normally wouldn’t get to connect to do so.”

Psychedelics & Safety Considerations

It’s common for people to have questions about the safety of psychedelic drugs and whether there are risks associated with them. Fortunately, classic psychedelics have little to no abuse potential. In fact, studies suggest they might even be anti-addictive. Even in vulnerable populations, it’s rare for complications like psychosis to arise from the use of psychedelics.

That being said, psychedelics may not be for everyone—which is why we take such great precaution before proceeding down the psychedelic path at our clinics.

 

What screening is done before deciding on psychedelics?

We only use psychedelics when there is a mental health-related diagnosis on record. We also complete thorough medical and psychiatric screening including reviewing pertinent factors such as personal or family history of psychosis and any history of substance abuse. Only after these precautions are in place do we consider psychedelic-assisted therapy.

 

Are these drugs safe?

According to many studies, the short answer is YES. Psychedelics have significantly lower risks than alcohol, cannabis, tobacco, and other drugs. Data from a study of psilocybin found that cases of mental health complications following a psychedelic are rare (<.1%), even in vulnerable populations (<.2%), and rarer still with proper screening. Another notable study, examining the classical (serotonergic, or 5-HT2A receptor agonists) psychedelics, LSD, psilocybin, & mescaline, found that no evidence of increased rates of mental health problems, and psychedelic use has been associated with reduced psychological distress and suicidality. Additionally, studies examining use patterns in humans & self-administration in animals suggest that classic psychedelics possess little or no abuse liability and may even be anti-addictive. These conclusions come from a comprehensive review of several kinds of psychedelic compounds, including classical psychedelics (psilocybin, LSD, &  mescaline), indirect 5-HT agonists, (e.g., MDMA), NMDA antagonists, and κ-opioid receptor agonists (KOAs).

 

Why do some people experience brief psychotic episodes even days after use?

There are several factors that can play into this. As a general guideline, people with cognitive & emotional conditions associated with disorganized or diminished ego strength are not good candidates for psychedelics. Regardless, however, the short-term psychological effects that accompany psychedelic use are profound. Sympathetic nervous system arousal may occur both because of fear, and from direct effects of the drugs--particularly during the initial phase of sessions when barriers between physical senses dissolve; touches, smells, and tastes can take on sounds, shapes and colors. Proper supervision is also important. These drugs’ effects are sufficient to require that professionals skilled in managing adverse effects are present, for safety & to guide patients through their experiences. Additionally, when taken without adequate preparation and when surroundings are anxiety-provoking—either physically uncomfortable or emotionally intimidating—the psychedelic experience predictably results in fear, a prolonged sense of dread, or full panic. Conversely, in controlled settings with elements of soft light, art, and appropriate music, or nature, and gentle, compassionate people, such adverse reactions are rare.

 

What conditions can Ketamine-Assisted Therapy (KAT) treat?

  • Depressive disorders
  • Post-traumatic stress disorder, post-traumatic stress and anxiety
  • Addictive disorders, including substance use and behavioural

 

What conditions are not suited Ketamine-Assisted Therapy at Numinus?

Absolute Contraindications - KAT is not a fit for those with the following conditions: 

  • Allergic reaction to ketamine
  • History of ketamine abuse
  • History of stroke or brain aneurysm
  • Uncontrolled high blood pressure
  • Acute Angle Glaucoma
  • Uncontrolled thyroid disorder
  • History of mania/bipolar 1
  • Age 14 and under
  • Current diagnosis of schizophrenia, schizoaffective disorder, major depressive disorder with psychotic features, psychotic disorder
  • Pregnancy (individuals who can become pregnant must use contraception if sexually active)

 

Relative Contraindications - We can some times treat those with the following conditions, on a case-by-case basis, with additional medical support: 

  • Active or unstable substance use disorder that is not an indication for treatment will be evaluated on a case by case basis by the screening physician
  • History of heart disease
  • Dissociative identity disorder
  • History of psychosis

 

Sources

Byock, Ira. “Taking Psychedelics Seriously.” Journal of palliative medicine vol. 21,4 (2018): 417-421. doi:10.1089/jpm.2017.0684

Heal, David J et al. “Evaluating the abuse potential of psychedelic drugs as part of the safety pharmacology assessment for medical use in humans.” Neuropharmacology vol. 142 (2018): 89-115. doi:10.1016/j.neuropharm.2018.01.049

Studerus, Erich et al. “Acute, subacute and long-term subjective effects of psilocybin in healthy humans: a pooled analysis of experimental studies.” Journal of psychopharmacology (Oxford, England) vol. 25,11 (2011): 1434-52. doi:10.1177/0269881110382466

Krebs, Teri S, and Pål-Ørjan Johansen. “Psychedelics and mental health: a population study.” PloS one vol. 8,8 e63972. 19 Aug. 2013, doi:10.1371/journal.pone.0063972

Physician Information — Ketamine-Assisted Psychotherapy

What is ketamine-assisted psychotherapy?

As you will likely know, ketamine is an anesthetic and analgesic used widely internationally. Ketamine also has antidepressant and psychedelic effects at certain doses, and international research has increasingly demonstrated that the combination of ketamine with structured psychotherapy can have benefits for a range of mental disorders. The ketamine assisted psychotherapy protocol at Numinus is distributed over approximately 4-6 weeks, depending on the patient’s schedule and how the visits are scheduled. Generally, the therapeutic protocol is expected to include two 50 minute introductory psychotherapy sessions without the use of ketamine, three ketamine dosing sessions of 2.5 hours in duration each followed within 24 hours by 90-minute psychotherapeutic sessions where insights from the ketamine experience are integrated, and a closing 50-minute psychotherapy (non-ketamine) session. Throughout this process, the psychotherapy delivered is focused on support, integrating insights, and identifying and reinforcing change as part of the therapeutic process.

Who is eligible for ketamine assisted psychotherapy?

Though research indicates that ketamine assisted psychotherapy may be effective for a number of mental health indications, Numinus is currently focused on addressing treatment-resistant depression. If you have a patient suffering from treatment-resistant depression that is interested in ketamine assisted psychotherapy, our team will work directly with them to determine whether the patient is a good candidate for treatment by taking a full medical and psychological history. To be eligible for ketamine assisted psychotherapy at Numinus, the patient must be referred by their primary care providers, such as a family physician or nurse practitioner.

What are the contraindications of ketamine assisted psychotherapy?

Those conditions that may make ketamine assisted psychotherapy contraindicated (i.e., potentially unsafe) include, but are not limited to, a history of psychosis (e.g. hallucinations), mania, cerebrovascular or cardiovascular disease, seizure, and severe liver disease. At present, youth, pregnant women and nursing mothers are not eligible for ketamine assisted psychotherapy since the effects of ketamine on pregnancy, nursing children, and youth are unknown. Additionally, the ketamine product monograph lists other risks which will be reviewed with all patients as part of an informed consent process at Numinus.

Episode 41: Jon Hopkins on Music for Psychedelic Therapy

 

“As if in each of us There once was a fire

And for some of us

There seem as if there are only ashes now

But when we dig in the ashes

We find one ember

And very gently we fan that ember

Blow on it

It gets brighter

And from that ember we rebuild the fire

Only thing that’s important is that ember

That’s what you and I are here to celebrate”

– Ram Dass quote, lyrics from “Sit Around the Fire”

Some big news before we get to the episode with Jon Hopkins: This episode of the Numinus podcast will be its last. Joe will be joining the team at the Psychedelic Therapy Frontiers podcast as a co-host. The Psychedelic Therapy Frontiers podcast is hosted by Dr. Steve Thayer and Dr. Reid Robison. It is a “weekly conversation about psychedelics, research and the therapy that makes them so powerful as agents for lasting change in mental health.”

This last episode of the podcast will also be hosted on any of the Psychedelic Therapy Frontiers platforms. You can more information about that here. Joe was also recently interviewed on the Psychedelic Therapy Frontiers podcast. You can find that episode on Apple PodcastsSpotify, and Google Podcasts.

 

In this episode of the Numinus podcast, Dr. Joe speaks with Jon Hopkins, musician and producer. Jon is a prolific musician who specializes in electronic music. He has been playing music for over 20 years. He has written six studio albums and has collaborated and produced albums for Coldplay and Brian Eno. His album, Singularity, received a Grammy nomination for Best Dance/Electronic Album in December 2018.

He also collaborated with Brian Eno to create music for Wavepaths. Wavepaths was founded by Mendel Kaelen and Anna Wakefield. The purpose of Wavepaths is to create therapeutic tools that integrate “psychedelic science, machine learning, music theory, psychotherapies and experience design, in collaboration with artists, therapists and researchers.”

His newest album, Music for Psychedelic Therapy, was specifically written to be used in psychedelic therapy sessions.

In this interview Dr. Joe and Jon explored:

 

Here is more information on subjects mentioned in this episode:

 

More quotes from Jon from the interview:

 

“That core wound, whatever that may be, we all have one, I think, of some kind. And we’re eternally trying to heal. As I got older and more in touch with that, I’m more and more clear that all the music-making is a direct response to that.”

 

“We all share great pain just through the nature of existence, and through the nature of what we witness and experience. We’re also able to share the healing of that and the joy that being alive can also bring. This album, whether consciously or not, has an expression of all those things in it.”

 

“When I hear [Music for Psychedelic Therapy] under the influence, I’m like, ‘Wow, where did that come from? Because it’s not me. It’s everywhere. It’s from everything.”

 

“All I know is that beauty is not an isolated feeling or concept. For me, the most beautiful things have a tinge of sadness or melancholy. Maybe beauty without sadness is meaningless.”

 

“What that ember is–to me–is the divine spark. When you connect to it, whether it’s through meditation or psychedelics, you sink into that place of total oneness or unity. It’s the inherent knowledge that there is a part deep inside of you that is shared by everyone. That is the divine spark.”

 

“The most important thing is daily practice because psychedelics open a door and occasionally you need a reminder that will get you there. It’s what you do everyday that has the biggest chance of fanning that ember.”

 

Here are some highlights from their conversation:

 

I want to actually ask you about the lyrics [of “Sit Around the Fire”]. I was really, really touched again listening to them recently. And if you’ll humor me for a second, I’m just going to read the last section so that the listeners know what we’re talking about.

 

“As if in each of usThere once was a fire

And for some of us

There seem as if there are only ashes now

But when we dig in the ashes

We find one ember

And very gently we fan that ember

Blow on it

It gets brighter

And from that ember we rebuild the fire

Only thing that’s important is that ember

That’s what you and I are here to celebrate”

I’m a little embarrassed hearing my own voice do that because on the track it’s just so beautifully performed by Ram Dass. But I wanted to ask you, from your really, really intimate relationship with those words in the music, what is the fire? What is the ember? What are we celebrating?

Let’s start with the ashes. You know, we often feel isolated, alone. We’ve kind of somehow been persuaded that all of this is meaningless to some degree. Some of us have–

I’m definitely familiar with the ashes, Jon [laughs].

Yes, we know what the ashes are.

Didn’t ask you about those [laughs].

Well, in order to think about the ember, it’s nice to think about the ashes, because I feel like as you said you’re familiar with the ember as well. I would say the stage I’m at is that I found that ember and I’m desperately blowing on it and trying to rebuild the fire. But really what the ember is to me is the divine spark.

When you connect to it, whether it’s through meditation, psychedelics or for me, it’s always the way the two inform each other, you sink into that place of total oneness and unity. And that’s  your inherent knowledge that there is a part deep inside of you that is shared by everyone that is the divine spark. I mean, the words for it don’t really cover it, but that’s there. And I think you touch on that sometimes. People with atheistic views will also touch on that, perhaps just not use the same words.

But, you know, you can feel that infinite oneness through looking at a landscape or gazing at a loved one or being in love or, you know, staring at your newborn child. That magic, that kind of ineffable wonder.

And in psychedelics, you get to spend some time there. You get to spend sometimes a few hours in that state. And when you’re in there, you’re like, ‘how will I ever not be like this again?’  Of course you come out and everything comes back. But in that time, you’re fanning the ember. You’re not forgetting everything. You come out–Okay, you go back to normal, but not quite back to normal. And each time you find it.

For me, the most important thing is daily practice for sure because psychedelics open a door, and on occasion, you need a reminder that they will get you there. But it’s what you do everyday that has the biggest chance of finding that end.

And then as to what the fire is, I like to think of it as the collective, all finding their own embers, and collectively, rebuilding the knowledge of our own innate divinity, that we need in order to make sense of this and also to survive.

And he’s also talking about infinities, talking about the fact that, after all, this is a belief system. It is really after your physical body is no longer with you. Consciousness is just, you know–your spark of consciousness just goes back to join the rest and you’re all one again. That’s what’ll happen in the end anyway. So maybe that’s what the fire is.

 

Connect with Jon Hopkins on Facebook and Instagram.

Connect with Dr. Joe on FacebookTwitter,LinkedIn and Instagram

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Teletherapy and Cyber Security

Important Disclaimer: This document is for informational purposes and general guidance only and is not advice on any specific regulatory or legal matter. Always consider getting qualified advice on the facts of any matter before proceeding.

In a world in the midst of the COVID-19 pandemic, therapists have had to adapt rapidly to continue offering psychotherapy. The main form of adaptation has been to transition to delivering  remote therapy, whether via telephone or video conferencing. Existing bodies of research have shown online therapy to be effective, but clients and therapists often still have concerns about privacy and security. Now is the time to directly address those concerns and it has fallen on me, as Numinus’s Clinic Manager to take on this challenge. My background as both a therapist and information technology professional helps me to understand and explain our approach to the delivery of remote sessions in the province of Quebec.

Numinus has always had a few therapists providing remote sessions to their clients; now it is the entire team. We have always abided by the rules governing the practice of teletherapy in our jurisdiction and will continue to do so. The Ordre des psychologues du Québec (OPQ), the governing body for psychologists and psychotherapists in Quebec, has produced several documents outlining the ethical and practical guidelines for remote therapy (in French only). I will briefly summarize these documents:

OPQ Guidelines for Psychologists/Psychotherapists practicing in Quebec

Encryption, End-to-End Encryption, and You

Encryption is a way to obfuscate the contents of a message, or video, so that only someone with the proper decryption key can undo the encryption and see the contents of the encrypted communication.  End-to-End (E2E) encryption adds an extra layer of security so that even the provider of the tool or service cannot decrypt the contents of communications, even if compelled to by law, or hacked by a malicious actor who inserts themselves as a “man in the middle” at the corporate level (e.g., at a software company’s servers that offer the teleconferencing solution).

The most common questions that arise from these guidelines relate to encryption. Does your therapist use a tool that encrypts your communication, preventing casual electronic eavesdropping by unsophisticated attackers? Good odds that the answer is yes, and at Numinus, we definitely do. All the tools listed by the OPQ use some form of encryption in order to prevent electronic eavesdropping.

PIPEDA, HIPAA, and Quebec’s “substantially similar” legislation

You may have heard people talking about various names for electronic privacy legislation passed in various jurisdictions and how they relate to remote practice. In the United States, there is HIPAA, in Canada there is PIPEDA. In Québec’s there is An Act Respecting the Protection of Personal Information in the Private SectorAn Act to amend the Act respecting health services and social services, the Health Insurance Act and the Act respecting the Régie de l’assurance maladie du Québec, all of Québec’s privacy laws relating to health records. The most important things to know about all of these laws, from Numinus particular perspective:

What you can do to help ensure that your sessions remain confidential

When it comes to security, you are more likely to have your remote session’s privacy violated by a person physically listening in from a nearby location than by a sophisticated state actor capable of breaking encryption or inserting themselves as a “man in the middle” attacker (e.g., the National Security Agency in the United States). The corporations offering these communication services have a vested interest, both legal and financial, in maintaining the privacy of these communications, so unless compelled by court order, they will not intercept any remote communications or turn over any recordings (which they all state that they do not even make in the first place). One could argue that you are as likely to have an in-person session bugged by law enforcement as to have a court order issued mandating that a session be captured and decrypted. If this is a real concern of yours, due to your work or other factors (e.g., you are a high level government official, famous actor, or crime lord), then online sessions might be best avoided! If you are not generally at risk of being a target of a state-level actor or law enforcement, you can also do some basic things to best assure your privacy:

  1. Make sure you are initiating sessions from a place where you can monitor, and ideally control, your environment to prevent someone from physically listening in.
  2. Do not use public WiFi networks when engaging in remote therapy unless there is absolutely no other choice. And if you must use public WiFi, then you must use a Virtual Private Network (VPN) software solution to provide an additional layer of protection to your communications.
  3. Regularly run virus and malware scans of your computer, or use your mobile device for your remote session, as they are far less prone to viruses and malware.

I hope this helps to inform you and address any concerns you might have, whether as a therapist delivering remote sessions, or a client on the receiving end!

Mental Health Services Transition to Online Care

The coronavirus pandemic is wreaking unprecedented havoc on our healthcare system, economy and communities. The combination of high stakes, uncertainty, lack of control and limits on social connection is creating a perfect storm for psychological distress. Undoubtedly, there is a mental health crisis lurking underneath the public health and economic crises unfolding before our eyes. And this, while everyone is forced to stay home.

The one bit of good news is that psychotherapy works online. Numinus has been offering virtual sessions for many years. But in the last week, we managed to transition our entire clinic operations online. While the virtual therapy session takes some getting used to—for clients and therapists alike—the results have been positive. Clients are grateful that they continue to have access to services. Sarah, one client said “I still had a real connection with my therapist, still able to make progress on issues that I have been working on for a while, and reduction in anxiety from what’s going on today.” Therapists also report that they are having positive experiences despite the remoteness. Jessica said “I’ve been pleasantly surprised by the quality of the connection I’m making with my clients despite the distance.” Julien even found some clinical advantages to virtual sessions: “I also find that there are advantages to meeting clients in their natural environment.”

The research on virtual psychotherapy supports these experiences. A 2012 review paper by Backhaus et al. concluded that virtual therapy is “feasible, has been used in a variety of therapeutic formats and with diverse populations, is generally associated with good user satisfaction, and is found to have similar clinical outcomes to traditional face-to-face psychotherapy.” Surprisingly, according to Simpson and Reid (2014), meeting a therapist online does not seem to compromise the quality of the client-therapist relationship, which is an important ingredient in successful therapy. So good quality mental health care is available online.

This mental health crisis is affecting organizations as well, as they rely on the sustained performance of their people to adapt to sudden, tectonic shifts in the business landscape. Virtual psychotherapy may be an essential ingredient to maintain employees health and functioning at work. Many organizations try to support employee well-being by offering extensive health insurance benefits. In this post-COVID world of social isolation, the primary headwind to employee wellness are feelings of anxiety and disconnectedness that arise from suddenly being thrust into working from home in an uncertain world. Psychotherapy is typically covered under these policies, but often not sought out. Alayacare, a Montreal-based health tech company contributing to COVID-19 solutions, is encouraging employees to make use of these benefits. CEO Adrian Schauer says “we are aware that some of our people are having difficulty coping with the current circumstances, which is totally understandable. We feel like working with an organization like Numinus to give our people access to licensed mental health professionals just makes sense.”

The insurance companies providing mental health coverage are just as motivated to facilitate services. For one, like many of us, they are often looking for ways to make meaningful contributions to their communities in this crisis. They also fundamentally want their customers to get good value for their policies, or else organizations won’t renew their policies. For example, SunLife’s  indicates: “We want to ensure plan members continue to receive the health care they need. Now, we’ll cover virtual services for appointments where they do not need direct physical therapies.”

Do you work with or represent an organization looking to support its employees through this crisis? Have a look at Numinus comprehensive offering for organizations during the COVID-19 crisis.

Acceptance and Commitment Therapy: 6 Skills to Living a Richer and More Meaningful Life

Acceptance and Commitment Therapy, or ACT (pronounced in one word), was developed by Dr. Steven Hayes and his research team and has, in the last decade or so, become one of the leading mindfulness-based interventions. One of its biggest strengths is that it is an evidence-based psychotherapy, with literally dozens of peer-reviewed research articles being published every month investigating its effectiveness in a wide range of contexts.

Although based on a cognitive-behavioural framework, it is heavily influenced by mindfulness concepts. Like other mindfulness-based interventions, ACT is not focused on changing unpleasant events or reducing symptoms, but rather to learn how we can make room for them and live a good life in spite of them. However, unlike other mindfulness-based therapies that involve long hours of formal meditation, ACT targets specific skills that can help cope with distressing events through brief exercises. This is especially helpful for those who are having difficulty meditating for long periods of time. These skills are based on the premise that distressing experiences are inevitable so learning how to cope with them is important, and that doing so allows us to live richer and more meaningful lives. The therapy consists in learning 6 skills, some of which focus on how to cope with unpleasant events, and others on how to live a meaningful life by making wise decisions.

1. Defusion

The first skill targets the destructive potential of thoughts. Being fused with thoughts means buying into them, or taking them literally. Conversely, being ‘de-fused’ from them means perceiving thoughts as simply thoughts, no more, no less. Defusing ourselves from thoughts that we have allows us to create some distance between our troubling thoughts and ourselves. This doesn’t mean getting rid of them but helps remove the emotional impact that they have on us. There are plenty of defusion exercises, for instance, a distressing thought such as “I’m a loser” can be repeated very rapidly until it loses its meaning, or can be tagged on after the stem “I am having the thought that…”, which also helps realize that it is just a thought passing through awareness and is not necessarily an accurate representation of reality.

2. The Observing Self

After some practice defusing oneself from unhelpful thoughts, we begin to notice that there are thoughts and there is an awareness of these thoughts, and that they are not the same thing. It soon becomes experientially apparent that while experiences continuously come and go, the awareness of these transient experiences itself is consistent and unchanging. Redefining oneself as the observer of experiences rather than as the experiences themselves, allows us to feel less directed by thoughts and thus freer to act volitionally. To facilitate understanding of this unusual concept, certain metaphors are used, such as comparing the self as a chessboard and thoughts as the pieces on the chessboard.

3. Acceptance

Having a range of experiences, even bad ones, is normal and part of being human. What creates distress is resisting these experiences and trying to avoid them. Another skill that is taught in ACT is being willing to allow all experiences, even unpleasant ones, to co-exist with us in every moment. Accepting unpleasant events is easier said than done but becomes easier the more it is practiced.

4. Contact with the Present Moment

Ultimately, life is always unfolding right now. So to live a rich and full life we have to be here now for it. By practicing accepting one’s experiences as they are, it becomes easier to remain for extended periods of time in the present moment. By doing so, not only are we enriching our life experience, we are also no longer avoiding troubling situations but learning to live with them.

5. Values

In order to live a meaningful life, it is essential to identify our deepest values and subsequently behave according to them. Identifying values requires taking the time to ask ourselves what is truly important to us.

6. Committed Action

Knowing what is important to us is not enough to live a meaningful life. The important last step is to commit to acting in accordance to these values despite the many obstacles that life regularly throws our way.

In essence, ACT is a means to become more aware or what we are experiencing from moment to moment, and more aware of what we truly care about. By no longer getting caught up in automatic (and often unhelpful) thoughts and actions, we develop the ability to become more flexible in the decisions we make and ultimately the way we chose to live our life. Our actions are made more consciously and are guided by what is deeply important to us.

Want to learn more about ACT? Many of our psychologists have trained in ACT for individual therapy, and we also offer group therapy programs based on ACT, as well.

 

This is an updated version of an article originally published on July 19, 2015