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How to find an Ethical & Skilled Therapist

This is a Harm Reduction Document. It does not replace medical or therapeutic advice. You acknowledge that you alone are responsible for doing your due diligence if you are to read beyond this disclaimer.

This is a living document and may change as community input is integrated.  Please feel free to comment.

FINDING AN ETHICAL AND SKILLED PSYCHEDELIC GUIDE CHECKLIST

This questionnaire is for individual sessions.  Additional questions to ask for group sessions are not addressed here.

For the purpose of this document the word ‘guide’ will be used to include all psychedelic space holders including therapists, psychotherapists, psychologists, clinical counsellors, sitters and shamans etc.

CONSIDERATIONS AND QUESTIONS TO ASK BEFORE DECIDING TO WORK WITH A GUIDE

  • Do they agree to the Code of Ethics?  (Soon to be created.)
  • How do you feel around them?  Even a sitter with a lot of experience and a great reputation may not be a good match FOR YOU. Tune into your body and notice if there’s a sense of relaxation and openness or are you feeling some ambivalence and tension? Don’t base your decision solely on a sitter’s credentials.
  • Has the medicine they’re using been tested and does it come from a reliable source?
  • What is their personal experience in working with this medicine?

A sitter must have experience with the medicine you will be using in order to understand the terrain that you will be navigating.  I.e.  You wouldn’t hire a guide to take you to the summit of Mt. Everest if they had never been there themselves.

  • What is their therapeutic background?  

Although formal training does not necessarily mean that they will be a good psychedelic guide, and there are many excellent guides with no formal therapeutic background, it does give you some idea of what kind of experience they’ve had in working with people in vulnerable and non-ordinary states of consciousness.

  • Do they have any formal or informal training in working with psychedelics?  

Outside of clinical trials, there has been very little formal training offered in working with psychedelics due to the legality of the substances.  Most training offered has been underground although that’s rapidly changing. Check their reputations by asking around and doing your own research.

  • Approximately how many ceremonies/treatments have they facilitated?

Psychedelic therapy is very nuanced work that can only be learned by experience.

  • Do they have a co-therapist/guide or do they work alone?  

It’s recommended that there be two guides in the session whenever possible.  This is for the comfort, safety and accountability of all those involved. If they work alone will they allow you to bring in a trusted friend as the second sitter?  

  • Have they done a comprehensive intake of your physical and psychological well-being to assess if you’re a good candidate for this session?  

There are definite contraindications for certain mental health and physical conditions as well as medications.  Be as honest and accurate as possible during your intake to ensure your own safety.

  • Ask the guide how they see their role in preparing for the session, facilitating the session and integration of the session.  This will give you some idea of how they work and if their style is compatible with your expectations.
  • How do they see the role of the ‘inner healer/wisdom’? 

It’s your own inner healer/wisdom that will navigate your experience and guide you where you need to go. The guide’s role is to gently support and encourage you to contact your inner healer/wisdom and to create an environment of complete safety in which you will be supported in a non-judgemental, unconditionally loving, and accepting way during your entire journey. 

  • What is their plan in the case of a physical, emotional or spiritual emergency?
  • What style or approach do they offer i.e. psychotherapeutic, psycho-spiritual, shamanic, somatic?  
  • What other modalities do they use in their sessions i.e. energy work, breathwork, somatic?
  • What setting will the session take place in?

You want to make sure it’s going to be a comfortable, quiet and safe environment free from outside interference.

  • Would they agree to arrange for you to talk to one of their previous clients?

This can be a way of being reassured that you’re in good hands.

  • Are they part of a peer support group

Are you invited to contact members of the peer group for a testament to their character and skill as a guide?

  • Do they make an audio recording of the session for your use afterwards? 

This can be a useful tool during the integration phase but not all guides will record the session.

  • If you raise concerns, issues, or fears, how does the guide handle them? 

If your concerns are dismissed or minimized, this could be a red flag.

  • Have they talked to you about intention setting and the reason you want to have a psychedelic session?
  • Do they use any kind of ceremony/ritual in their session?  

Many guides and sitters begin and end the session with a ceremony or ritual.  If this is not in alignment with your religious or cultural beliefs let them know.  If you’re not comfortable with the ceremony/ritual being offered, will they work with you to create a ceremony better suited to you?  You can also ask that there be no ceremony or ritual if that’s your preference. 

  • What are their views around the use of touch?  Are they trained in any somatic modalities? ( See Red Flags below).
  • Have you received your guide’s rules about leaving the space during a session?
  • How long will they stay with you after the treatment/ceremony?

Your sitter should stay with you until you feel physically, mentally and emotionally ready to leave the space before venturing back into the world.  You will be in a vulnerable state and the ‘outside world’ may feel harsh.

  • Is there an integration session within 36 hours of the session?

It’s very helpful to touch base with your sitter within a day or two of the session.  This is the beginning of the integration phase and a lot of emotions, memories and insights can come up.  Checking in with your guide can help to ground the experience and give you confidence that all that you’re experiencing is a normal part of the process.  If you’re having difficulty making sense of the experience they can also help you to learn ways of integrating what may be a new way of viewing the world.

  • What kind of integration and after care is being offered?

If ongoing integration is not part of the arrangement you have made with your guide it’s highly recommended that you find someone to process your experience with.  If you have limited financial resources it can be helpful to talk to a trusted friend or join an online integration group.  Many of the psychedelic societies and associations around the globe offer integration groups which you can find on Facebook or Meetup or by Googling integration groups.

  • Does the guide use medicine themselves during the session? 

Some guides use micro or small doses of the same medicine as you as a way of tuning into you and the ‘energy of the medicine’.  Many ethical lapses emerge when a sitter is on a high dose of medicine (vs micro-dose) and their boundaries are relaxed.  

The guide should be the sober one in the room!

Definition of sober sitter.

Being able to attend to the client’s physical and emotional needs without hesitation and with impeccable and appropriate care and integrity. 

  • What medicine and dose will be used? 

There’s a wide variation in effective dose.  Your sitter may suggest that you do a test run beforehand with a low dose to assess your tolerance to the medicine.  i.e. 5 grams of Psilocybe cubensis may be the perfect dose for one person and another will need 2.5 or even 8 grams for a similar effect.  

For more info on drug interactions here are some good resources:

Psychonautwiki https://psychonautwiki.org/wiki/PsychonautWiki  

Spirit Pharmacy https://www.spiritpharmacist.com/consultation

Bluelight  https://www.bluelight.org/xf/

Third Wave  https://thethirdwave.co/psychedelics/#

Erowid https://www.erowid.org/

  • How do they record your information and protect your confidentiality?  

Only regulated health care workers are legally required to protect your confidentiality although all ethical providers will do so.  If you are concerned about this talk to them in advance.

  • What are they charging and what method of payment?

Due to the current legal status of these substances in Canada most guides will ask to be paid in cash to avoid a paper trail.

A BIT ABOUT PREPARATION

You’re about to engage in what may be one of the most fascinating, beautiful and transformative experiences of your life.  You may also experience some difficult moments as past traumas are recalled and integrated during and after your session. Please keep this in mind as you read through the safety measures we’ve outlined that are designed to ensure that you have the most healing and positive experience possible.  

PREPARING YOUR MIND AND BODY

A psychedelic journey can begin the moment you decide to do one, rather than the moment you ingest the medicine. By focusing your attention inward for a period of time each day leading up to the session, you can lay the foundation for the deep inner work you’ll be doing.

This is the time to tune into the reason you are doing this session. What brought you to this decision in the first place?  What do you hope to get out of it? Writing it down can be helpful in gaining clarity about your reasons and deepest longings.

Preparation includes eating well, getting plenty of rest and exercise, and most importantly, finding time to ‘do nothing’ and quiet your mind.  This may mean walks in nature, meditation, yoga, journaling etc. Learning and practicing relaxation breathing exercises in advance can be very helpful in the event that you encounter difficult moments during your session. 

EXPECTATIONS AND INTENTIONS

If you have a strongly held expectation of what will happen, you may miss the gifts of wisdom and healing that are actually being offered.  Keeping an open and curious mind about what’s going to unfold will be of huge benefit.

As the Rolling Stones say, “you can’t always get what you want, but you know  somehow, you’ll get what you need”.  This is very true for working with psychedelics.  

And, as Deepak Chopra says, “relinquish your rigid attachment to a specific result and live in the wisdom of uncertainty. Intend for everything to work out as it should, then let go and allow opportunities and openings to come your way.”

PHARMACEUTICALS

If you’re on SSRI’s, there are certain psychedelic medicines that you shouldn’t be combining with them. You’ll want to talk to your doctor about how to slowly wean off of them so that they can clear your system for at least 2 months before your session. 

If you’re on other medication talk to your guide in advance about them.

For more info on drug interactions here are some good resources:

Psychonautwiki https://psychonautwiki.org/wiki/PsychonautWiki  

Spirit Pharmacy https://www.spiritpharmacist.com/consultation

Bluelight  https://www.bluelight.org/xf/

Third Wave  https://thethirdwave.co/psychedelics/#

Erowid https://www.erowid.org/

OTHER PSYCHOACTIVE SUBSTANCES

Your guide should ask you about other psychoactive substances you’re taking and let you know if they will adversely interact with the medicine you’ll be using in your session.  If they haven’t, take it upon yourself to ask about it.

SEXUAL TOUCH

According to the Code of Ethics of the CPA and the members who have agreed to them, sexual touch with your guide should not happen before, during or after your psychedelic session. 

In the therapy world, it’s unanimously agreed that there is an inherent power differential between the guide/therapist and the client that can’t easily translate into a balanced, healthy dual relationship.  

Given the prior agreement that there will be no sexual touch, if this becomes difficult for either party to maintain, the guide should refer the client to another therapist.

RED FLAGS

There are some psychedelic ‘therapists’ who are offering what they call Erotic Medicine Journeys or calling themselves Sacred Whores/Prostitute/Gigilo etc. There have been several reports from their clients expressing how there wasn’t consent given to sexual touch beforehand which resulted in great harm to their mental well being. Sexual interference can also happen with speech and on an energetic level.  What may feel right in the moment under the influence of medicine will inevitably turn into a very conflictual state.  

Psychedelic psychotherapists have found that in order for the deepest healing from sexual trauma to occur, there must be a high level of trust with the therapist and this isn’t possible when there is sexual acting out.

There are trained sex therapists and sex surrogates who have received substantial training in this area.  These ‘Sacred Prostitutes’ (et al) do not fall into that category.  If you’re considering working with those who include sex practices in the session there should be a clear informed consent in advance around what this will include.  

Non-sexual touch can be very helpful in the healing process.  A discussion around the use of touch should happen prior to the session.  If you have not consented to the use of touch it should not happen unless you are physically endangering yourself or others.  Even if you have given prior consent, you can change your mind at any point during the session. The sitter should discuss with you in advance how you can convey a change of consent such as a hand gesture, using the work STOP, or any other method that you agree on.  

Ethical violations can be more than inappropriate touch. When a guide inserts themselves into your treatment in an energetic, physical, or spiritual way, it may violate your ‘safe container’ when you are most vulnerable.  A good way to assess whether the guide is trying to take control of the session is by noticing if you are feeling more in touch with yourself or if you’re feeling more of your guide on the outside.

Be wary of guides who speak about how they can heal you. The guide’s role is to support your ‘inner healer/wisdom’ that these medicines allow us to get in touch with.  The healing comes from within.  

Be wary of guides who appear to know it all or tell you what your experience will be. They may have an idea of the broad range of experiences that are possible but there is no way for them, or even you, to know what your experience will be in advance and each session can be vastly different.  The guide and client should both enter into it with a sense of curiosity and openness. Find a guide who is humble and willing to learn from you.

Ask your guide/sitter why they are suggesting a particular medicine for your session.  If you’ve been looking forward to a Psilocybin session and your therapist wants to use MDMA instead you’ll want to understand why.  The decision around which medicine is used should be made together with your guide/sitter. 

    SUGGESTED BOOKS

    The Psychedelic Explorer’s Guide – James Fadiman

    Manual for Psychedelic Guides – Mark Haden

    In the Realm of the Hungry Ghost – Gabor Mate, MD

    Consciousness Medicine – Francois Bourzat

    William Richards – Sacred Knowledge

    How to Change Your Mind – Michael Pollan

    OTHER – HARM REDUCTION
Zendo Psychedelic Harm Reduction https://zendoproject.org/wp-content/uploads/2017/06/Zendo-Manual-2017.pdf

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