Five years ago, clinicians at Oregon-based Portland Psychotherapy didn’t hear much about the use of psychedelics among its patient population. In the past year or so, however, client use and interest has skyrocketed, says psychologist Brian Pilecki, PhD. As such, the team there decided it was important to support clients in a trained, research-based fashion.
While the clinic is also a psychedelic research center, Pilecki says the Portland team sought out specific training from Fluence, a New York-based program designed to assist clinicians in psychedelic integration. “We see a growing number of clients who seek out psychedelics on their own,” says Pilecki. “We want to support that population as best we can.”
Pilecki attended a Fluence training session in 2018 prior to joining the practice in Portland. He left armed with the tools he needed to assist patients curious about, or using, psychedelics. As the use of psychedelics grew and exploded, he suggested the Portland team participate in the training as well. “The two-day training provides the background and research-based results to create a community of therapists interested in integration work,” Pilecki says. “Fluence approaches the topic with scientific rigor, caution, and humility.”
Psychedelic Integration Training
Up to 10 percent of the U.S. population has tried psychedelics at one time or another, according to Ingmar Gorman, psychologist and co-founder of Fluence. “With trends to decriminalize the drugs in some states, and widespread media coverage, we’re witnessing a big uptick in interest about their therapeutic applications.”
While this demand for psychedelic treatment is growing, the clinical world largely lags behind. “When you go through medical school, there’s very little time dedicated to learning about psychedelics and their applications,” explains Gorman. “We want to help clinicians get up to speed so that they can responsibly handle this clientele.”
Fluence focuses on psychedelic integration training for clinicians as a way to guide their clients through the experience. This does not mean administering the drugs, nor does it mean accompanying patients while they trip, or encouraging seeking them out at retreats and other settings.
Instead, psychedelic integration aims to help clients understand and process their trips. “These are complex experiences and it’s key that therapists have an understanding of that in order to best serve their patients,” added Gorman.
Key to this is assisting patients in harm reduction, a core component of the Fluence training. Harm reduction includes a spectrum of interventions aimed at reducing the negative effects of health behaviors without necessarily seeking to eradicate them. So, while the use of psychedelics may be helpful to some patients in working through depression, anxiety or PTSD, it may bring with it a host of negative impacts. Harm reduction therapy works to minimize those impacts.
“Using psychedelics outside of a clinical setting can be unpredictable,” explains Elizabeth Nielson, psychologist and Gorman’s co-founder. “We train therapists to respond to these situations.”
In the case of Portland Psychotherapy, for instance, Pilecki learned to take the stance of not encouraging clients to do anything illegal, while understanding they may do just that. “My role is to provide clients with an understanding of the full risks and benefits and empower them to make the right decisions for their particular situation,” he says.
Psychedelic experiences might include an exacerbation of symptoms, such as heightened anxiety or depression, for instance, or a negative trip that returns a patient to an intensely traumatic event. When therapists are trained to expect and respond to this, they can greatly improve a patient’s outcome.
Fluence training sessions vary in topic and duration, but their introductory program includes an overview and history of psychedelic drugs, current research findings on the topic, integration and harm reduction therapy training. Nielson points out the importance of the historical aspect. “There was a good deal of valuable research with psychedelics in the ‘60s,” she says. “It’s important to visit that body of work and learn from it.”
At Pilecki’s suggestion Portland Psychotherapy hosted Fluence for an introductory training, attended by around 50 staff and local clinicians. “There are other training groups popping up these days, but we went with Fluence because it offers continuing education credits, which further validates this area of treatment,” Pilecki explains. The training doubled as a fundraiser for Portland Psychotherapy’s MDMA-assisted therapy research study.
The two day live-online program included didactic training, role playing, Q & A sessions and more. “We set up groups of three so that each member can have a chance role playing as patient, as therapist, and as observer,” explains Nielson. “We also teach therapists to identify potential contraindications, and patients at higher risk for negative consequences.”
In addition to online workshops and in-person retreats, Fluence offers 12-week online classes broken into hour-and-a-half long sessions. These cover topics like psychological approaches to psychedelics therapy, integration essentials, and psychedelics and social justice.
To date, nearly 700 clinicians have taken part in Fluence training, and in the current environment, that’s probably the tip of the iceberg. That’s a good thing, says Pilecki. “In Oregon, the law change to decriminalize psychedelics will certainly increase its usage,” he says. “That won’t change how I operate as a therapist, however, and my primary focus will continue to be harm reduction.”
Pilecki likes the fact that following the training, he and his fellow therapists became part of a list-serve made up of fellow Fluence attendees. “This has been very useful,” he says. “I go in regularly to bring up questions that arise as I treat different clients. Given the fact that this is a newer clinical application, we’re always running into new areas where we can use consultation with other therapists.”
As soon as next year, the FDA may begin to approve therapeutic uses for a variety of psychedelics. The role of clinicians trained in psychedelic integration therapy will become more critical than ever, as will the need for formal training in psychedelic-assisted therapy. Fluence is ready to meet that call.