January 2022 Article

In 2018, I left a steady-paying job as a traditional talk therapist to enter the world of psychedelics as a ketamine-assisted psychotherapist. Like many therapists who make this transition, I had personally experienced the profound healing power of psychedelics and felt inspired to find avenues for patients to access the benefits. Ketamine, with its promising research on alleviating Treatment Resistant Depression and PTSD, seemed like a favorable option to explore as a psychotherapeutic agent.^1,2

When I told my father of my career change, he responded somewhat bewilderedly, “I hope you know what you are doing!” Having worked as a training director and supervisor of interns and students for many years, I shared his sentiment regarding the necessity of knowledge, skills, and a good plan to becoming a competent professional. I also reassured him that ketamine is a legal drug, and I didn’t anticipate losing my license to practice.

A host of training programs, certificates, and experiential workshops exist to help therapists make the transition from ordinary to non-ordinary states of therapy. And the field is defining—and redefining—the core competencies necessary to practice with integrity in the field of psychedelic psychotherapy.

Janis Phelps from California Institute of Integral Studies compiled a list of six core competencies that are a solid summative foundation.³ These include:

• Empathic Abiding Presence

Phelps notes that psychedelic sessions can include unusual experiences, unfamiliar physiological effects of the drug/medicine, and challenging moments which necessitates therapists and guides convey a composed, calm, and empathic curiosity to help clients navigate unusual waters.

• Trust Enhancement

Phelps identifies the need to be a dependable and reliable guide, both trusting a client’s internal wisdom, as well as traversing the unexpected as it emerges within a session.

• Spiritual Intelligence

This competency includes familiarity and comfort with mystical experiences, existential themes and meaning making, and experiences of transcendence and awe.

• Knowledge of Physical and Psychological Effects of Psychedelics

This area of knowledge may include past and contemporary understanding of indigenous traditions, as well as physiology and pharmacology. In addition, assessment of appropriateness of fit, contraindications for psychedelic-assisted psychotherapy, adequate preparation, and subsequent integration of material that arises is important. A therapist’s own experience with psychedelic medicines assists with this knowledge.

• Therapist Self-Awareness and Ethical Integrity:

This competency addresses maintaining appropriate boundaries with clients in vulnerable spaces, adhering to ethics codes, awareness of transference, countertransference, projections, and therapists’ own issues that get triggered by psychedelic work.

• Proficiency in Complementary Techniques:

A host of skills and methods are available that complement psychedelic session and integration work including mindfulness skills, meditation, third-wave CBT theories, breathwork, somatic therapies, and many more.

The recent renaissance of psychedelic use has highlighted a crucial aspect of the conversation—the voice, recognition, and inclusion of diverse and intersectional perspectives of BIPOC, immigrant, and LGBTQ-identified research participants, therapists, guides, and clients. This often includes acknowledgement of indigenous traditions that inform current ritual and psychedelic healing.^4.5

Woven through the core proficiencies above, as well as a stand-alone competency, includes:

• Diversity and Inclusion

Skills may include assessment of power, privilege, discrimination, racism, microaggressions, intergenerational impact of oppression, disparate impact of the “war on drugs” and exploration of therapist-client identity variables as part of set/setting preparation.⁶ A therapist’s own identity work and on-going capacity to assess, explore, and process the impact of trauma on diverse identities such as race, ethnicity, gender, sexual identity, ability, class, and immigration status is crucial, in addition to advocacy for the voices that are missing.

The Multidisciplinary Association for Psychedelic Studies (MAPS) has spearheaded training for psychedelic-assisted psychotherapists as they pursue legalization of MDMA for treatment of PTSD, and their training manual is available on-line as a resource, addressing many of the above issues with depth and sensitivity.⁷

Finally, many organizations exist that provide ketamine-specific education, training, and community connection/support for providers. A few include KRIYA (Ketamine Research Institute), KTC (Ketamine Training Center), Polaris Insight Center, and of course ASKP³. For therapists curious about ketamine, ASKP is hosting a free webinar on January 18^th 2022 entitled What you Need to Know About Ketamine as a Therapist. The webinar aims to educate therapists on how ketamine may be useful for clients, as both a medical and a psychotherapeutic intervention via ketamine-assisted psychotherapy (KAP).

Dr. Cindy McKinzie is a clinical psychologist in Chicago, IL. She attended an experiential training through the Ketamine Training Center in 2018, and until recently she offered KAP at The Neuroscience Center in Deerfield. Dr. McKinzie is currently in private practice and can be reached at mckinzie@drcindymckinzie.com  Thankfully, her father is much less anxious about her career transition.

References:

1. Dore J, Turnipseed B, Dwyer S, et al. Ketamine Assisted Psychotherapy (KAP): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy. J Psychoactive Drugs. 2019;51(2):189-198. doi:10.1080/02791072.2019.1587556
2. Marcantoni WS, Akoumba BS, Wassef M, et al. A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 – January 2019. J Affect Disord. 2020;277:831-841. doi:10.1016/j.jad.2020.09.007
3. Phelps J. Developing guidelines and competencies for the training of psychedelic therapists. J Humanist Psychol. 2017;57(5):450-487. doi:10.1177/0022167817711304
4. Williams MT, Labate BC. Diversity, equity, and access in psychedelic medicine. J Psychedelic Stud. 2019;4(1):1-3. doi:10.1556/2054.2019.032
5. Halstead M, Reed S, Krause R, Williams MT. Ketamine-assisted psychotherapy for PTSD related to racial discrimination. Clin Case Stud. 2021;20(4):310-330. doi:10.1177/1534650121990894
6. Neitzke-Spruill L. Race as a component of set and setting: How experiences of race can influence psychedelic experiences. J Psychedelic Stud. 2019;4(1):51-60. doi:10.1556/2054.2019.022
7. Mithoefer MC. A manual for MDMA-assisted psychotherapy in the treatment of posttraumatic stress disorder. Amazonaws.com. Accessed December 12, 2021. https://s3-us-west-1.amazonaws.com/mapscontent/research-archive/mdma/TreatmentManual_MDMAAssistedPsychotherapyVersion+8.1_22+Aug2017.pdf