Fluence co-founder discusses the challenges of training a new generation of therapists with the skills and knowledge to administer psychedelic-assisted therapy.
Elizabeth Nielson, chief visionary officer and co-founder, Fluence
Psychedelic-assisted therapy is disrupting conventional approaches to treatments, where mental health practitioners traditionally rely on talk-therapy sessions that may last less than an hour.
The effects of psychedelics, lasting up to six hours or more depending on the substance, present new challenges for therapists looking to integrate psychedelics into their practice. Recent reports, including the first administration of an MDMA prescription in Australia, offer a preview of what the future may hold for psychedelic-assisted therapy.
Traditional four-year colleges and institutions that specialize in psychedelic therapy, such as Fluence, Naropa University and the California Institute for Integral Studies, are introducing new training programs to help prepare therapists for this new world.
Their work preparing mental health professionals for the next generation of therapeutic modalities will be critical with regulatory approvals on the horizon.
Mark Haden, an adjunct professor at the University of British Columbia school of population and public health, recently highlighted this urgency in an interview with CBC News, saying that Canada must train more health-care professionals in MDMA therapy in anticipation of FDA approval in the U.S.
“MDMA-assisted therapy is completely different from regular therapy and we need as many therapists trained as possible so when the door opens we can provide this service widely,” he said in the CBC News article.
Not Your Standard Therapy
Session duration is just one of the many distinct differences between psychedelic-assisted therapy and standard therapy.
“Therapists entering psychedelic training programs often lack experience in working with non-ordinary states of consciousness and may not be fully prepared for the intensity and depth of psychedelic experiences,” says Elizabeth Nielson, chief visionary officer of Fluence. “Many come from traditional therapeutic backgrounds that don’t provide models for navigating transpersonal experiences, facilitating integration of those experiences, and applying harm reduction principles in a clinical setting.”
Fluence trains licensed therapists and other mental health professionals on clinical practice skills related to psychedelic-assisted therapy in addition to education opportunities for individuals from a variety of other backgrounds.
Nielson, who co-founded Fluence with Dr. Ingmar Gorman in 2019, says one of the key challenges in training therapists for psychedelic work is ensuring they have the expertise to define their roles and operate within their professional boundaries.
“With so many patients seeking psychedelics as part of their mental health care or in other nonclinical environments, it’s essential that clinicians understand what is available by prescription, what can be used off-label and what is, and is not, available through the supervised adult-use model in Oregon,” she says.
In 2020, Oregon became the first state in the U.S. to legalize adult-use psilocybin, with service centers offering facilitated sessions and integration services opening in the summer of 2023.
Fluence helps its students understand the evolving legal status of psychedelics, so practitioners can provide patients with clear information and have confidence in their understanding of the laws, Nielson says.
The program includes training on practices aligned with the regulatory and legal environment. The legal status means Fluence cannot train students on all psychedelics, but those enrolled in the program participate in role-plays, therapy simulation exercises and self-reflection exercises to prepare for working in the field, according to Nielson.
Overcoming Misperceptions
In a traditional therapy session, a therapist takes an active role in analyzing a patient and providing feedback. But with psychedelics, a therapist may take on a more supportive position. Dr. Brian Richards, a psychedelic therapy researcher at Johns Hopkins University’s Behavioral Pharmacology Research Institute, discussed some of these issues during the online 2024 Psychedelic-Assisted Therapy Global Summit.
Therapists may not fully know what a patient is experiencing and should treat the medicine and music during a session as co-therapists, Richards told Fleet Maull, a meditation teacher and management consultant, in a recorded event session.
They must learn to trust the guidance that the medicine provides to patients, said Richards, whose father William Richards played a pioneering role in psychedelic research during the early 1960s and continues his work today.
A common misperception among participants is the belief that psychedelics alone can offer a “magic bullet” for mental health issues.
“Many initially underestimate the importance of the therapeutic process and the role of integration in facilitating lasting change,” Nielson says.
A dose of reality is also important for aspiring psychedelic-assisted therapists. Research is still ongoing and there’s still much to be learned about the impact of psychedelics.
“We consistently encourage taking an informed and balanced stance, evaluating the evidence and its limitations, and applying that knowledge in conversations with patients,” she says.
Fluence addresses these gaps by through comprehensive training, encompassing essential skills such as ethical and safe practices, knowledge of psychedelic pharmacology, proficiency in integration techniques, cultivation of therapeutic presence and adept handling of both positive and challenging psychedelic encounters, Nielson says.
“Our approach emphasizes up-to-date knowledge of clinical research, experiential learning, reflective practice, and the development of a nuanced understanding of the therapeutic relationship in the context of psychedelic therapy,” she explains.
Looking ahead, the future of psychedelic therapy holds great promise, with some treatments poised to become mainstream within the next five to 10 years. But making that a reality will require the training of thousands of clinicians, says Nielson.
“I envision a landscape where psychedelic therapies are widely available, supported by robust clinical evidence and integrated into healthcare systems with the necessary regulatory frameworks and trained professionals in place,” she says. “This future also includes a greater public understanding and acceptance of psychedelics as valuable therapeutic tools.”