Leading Their Patients on the Psychedelic Therapy Journey: Considerations for Clinicians

There are several “important considerations for the clinician” in preparing to help lead their client on the journey of psychedelic therapies, some of which include “harm reduction, risk reduction, and benefit enhancement; litigation and reputation; directive vs nondirective approaches; therapeutic listening vs clinical assessment; and competency” Julie Megler, PHH-NP, co-founder, Sage Integrative Health, Berkeley, California, told virtual attendees at today’s Sana Symposium.

Megler states that harm reduction, risk reduction, and benefit enhancement “are all nuances that are important to consider in the sense that differentiating between risk and harm reduction puts psychedelics in a different category than other harder street drugs, and that doesn’t necessarily help all the marginalized populations that are targeted by the drug war.”

The risk to the clinician is also something to consider when preparing patients for these treatments because “if your licensing board sees that you’re doing benefit-enhancement work, they can see that as you [are] advocating for an illegal substance at this point, so that could put your license at threat,” says Megler.

Other risks include both litigation and reputation. If a client has a poor outcome while on psychedelic therapies, a patient or their family member may decide to press charges. Also, “not all of our colleagues are on board with psychedelics being useful and therapeutic at this time,” which could change people’s perceptions and impact a clinician’s reputation.

Another consideration is weighing the difference between using directive versus nondirective approaches to therapy. “Usually in psychedelic-assisted therapy we emphasize nondirective approaches for the client to really trust their own inner healer and what emerges. And [there are] aspects in just creating the container in setting up safety for the client,” explains Megler. A more directive approach is best used during preparation work for client sessions.

‘Bright’ Yet Cautionary Future for Psychedelics as Evidence-Based Medicine

Meghler next compared therapeutic listening with clinical assessment in preparing for psychedelic therapy. With psychiatric providers, the tendency is to use clinical assessment and diagnosis, which is useful for initial screening purposes to ensure psychedelic therapy will work; however, clinicians will need to find a way “to check that at the door” so they can really hear the patient because “there’re going to be entering into a place of more visionary and symbolic realms.”

Megler then touched on the idea of the “wounded healer.” She notes that clinicians sharing personal wounds and healing can helping form a “therapeutic alliance” with the client, which can be controversial and bring up a vulnerability in some cases.

She clarifies that “I am not necessarily suggesting, with this idea of the wounded healer, that you should all go out and try psychedelics, but there is this idea that you can only take others as far as you have taken yourself. So, how much work you have done on yourself personally, internally is going to inform your ability to empathically meet your client.”

Megler concludes by stating, “Things to be aware of if you do decide to be a bit more vulnerable with your clients is being aware of things like counter transference, and compassion fatigue, and again possible judgment from peers and colleagues.”

Reference

Megler JD. Preparing for the journey: setting up for treatment. Presented at: Sana Symposium; September 17-19, 2021; Virtual.