As psychedelic therapy goes mainstream, Fireside Project's founder makes the case for professional coaching as a vital complement to clinical care.
Before devoting his life to the field of psychedelics, Joshua White spent more than a decade as a deputy city attorney at the San Francisco City Attorney’s Office, where much of his focus was on holding businesses accountable for exploiting vulnerable communities.
A lawyer by trade, White founded Fireside Project in 2020. The nonprofit operates a free support line for people in the midst of psychedelic experiences or processing past psychedelic experiences.
Prior to founding Fireside Project, White was a longtime volunteer counselor on Safe & Sound’s TALK Line and a psychedelic peer-support provider for the Zendo Project.
Psychedelic Medical News spoke with White about the roles that psychedelic coaching and support lines play in a safe and equitable mental-health ecosystem.
How does psychedelic coaching differ from guided sessions or “trip sitting?”
Fireside Project’s coaching program, which we call Fireside-Certified Psychedelic Coaching, is a paid service that provides long-term, scheduled support by video to clients who are preparing for a future psychedelic journey or who are wanting to integrate a past journey. All of our coaches have gone through a 30-step, 300-hour process that begins with a 250-hour apprenticeship on our Psychedelic Support Line.
Our coaches serve as a grounded, continuous presence for our clients, supporting them with whatever arises during their preparation and integration, whether that’s answering questions; helping them dive deep into why they’ve decided to take this journey and why now; which obstacles they may encounter and how to navigate them; answering questions; unpacking and exploring whatever arose during their journey; and supporting them as they apply what they’ve learned to their loves. Like with other telehealth services, our clients select the coach who’s right for them based on their photo and bio.
However, our coaches do not guide/trip-sit for clients during psychedelic sessions. If a person needs support in the midst of a journey, they can call or text Fireside Project’s free Psychedelic Support Line.
What protocols and risk-management strategies are being implemented in psychedelic coaching to ensure client safety and appropriate clinical referrals when needed?
First, all clients review and sign a legal document that describes the limits of our coaching program, including the fact that we are not a service for people who are actively suicidal or who have certain indications. Second, all clients fill out a detailed intake form. Third, by the time we hire a coach as a paid employee, they have spent over 200 hours on our Psychedelic Support Line handling crisis calls. We use similar procedures in our coaching program to transition callers who may be in immediate danger of death or suicide to emergency services.
In addition, coaches receive weekly supervision based on a clinical model from our director of coaching, Dr. Jacob Ham, an associate clinical professor in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. In those supervision sessions, coaches can discuss any issues related to potential risks clients may be facing.
With the emergence of legal psychedelic services in several states, how can medical professionals effectively collaborate with psychedelic coaches as part of an integrated care team?
I want to distinguish between psychedelic coaching generally and Fireside Project’s coaching program specifically. As a general matter, psychedelic coaching hasn’t been considered a serious modality to help fill large gaps in care. That’s because anyone can call themselves a coach with little or no training, and although there are some training programs, they typically sell their certifications to anyone who can pay, they offer no ongoing supervision, and all coaches are lone wolves – either solo practitioners or independent contractors who are accountable to no one.
Fireside Project’s program takes a different approach. To my knowledge, we are the only company to do all of the following: train our coaches; hire them as employees; and provide them with rigorous weekly supervision. Plus, there’s accountability. All clients receive post-session surveys, and responses are transmitted to Fireside Project. This enables us to track the level of support clients are being provided.
We built our program to become part of the delivery of both clinical and non-clinical care. We are in talks now to partner with research institutions, clinical trial companies and a range of psychedelic businesses to give their clientele access to our coaches either as an alternative or complement to psychotherapy.
What standards and accountability measures should the medical community look for when evaluating psychedelic coaching programs or making referrals?
The reality is that, at a systemic level, psychedelic coaching can’t be taken seriously as a support modality. As I mentioned, anyone can call themselves a coach no matter how little training they have, and there is almost never accountability for ethical transgressions, in large part because coaches typically operate as lone wolves. To be taken seriously, I think a company has to do what Fireside Project has done: train its coaches; hire them as employees; provide them with weekly supervision; collect data on their performance; and hold them accountable in the event of any transgressions.
How is outcome data being collected and evaluated in psychedelic coaching, and what metrics are being used to assess effectiveness?
At Fireside Project, we gather extensive data. Before we hire someone as a coach, we evaluate them for a full year as a volunteer on our support line, where supervisors and callers rate their performance across a variety of metrics. At the end of their year, a holistic review of their performance is conducted, followed by a written application and an interview. Once we hire them as paid employees to coach, we provide them with weekly supervision and clients receive surveys after every session that invites client feedback on a range of topics.
What role can psychedelic coaching play in harm reduction and public health as psychedelic-assisted therapies become more mainstream?
Fireside Project’s coaching program can play a vital role in harm reduction. Psychedelics are safest when people rigorously prepare for the experience beforehand and diligently integrate the experience afterwards. The absence of such support can create risks. Therapy is great for some people some of the time, but therapy is out of reach for many people – it’s often not covered by insurance and people may not be able to afford to pay out of pocket. Plus, therapy is an imperfect fit for many psychedelic experiences, which sometimes lie outside the bounds of Western psychological models. Our coaching program was designed to fill this gap in long-term support.