As recent trials of psychedelic-assisted psychotherapy enter the last phase of testing, the coming need for many trained therapists and guides seems inevitable. Until recently, the only opportunity to train and work legally as a psychedelic therapist was in clinical trials. That will likely change over time as expanded access becomes the next step for current trials (evaluating MDMA and psilocybin) and if psychedelic-assisted therapies become FDA approved.

Many people are looking for information about psychedelic therapy and opportunities to become guides or therapists after reading Michael Pollans new book HowtoChange Your Mind: What the New Science of Psychedelics Teaches Us about Consciousness, Dying, Addiction, Depression, and Transcendence [1]. Providers are seeking trainings to become more informed about psychedelic experiences. They also want to know how to become certified to administer psychedelics in clinical trials and potentially post approval.

Still, there remain many unknowns about what training programs outside of the drug sponsors will be acceptable by FDA to dispense MDMA or psilocybin post-approval. FDA has never regulated psychotherapy, but medical devices often require training in a certified program. Demonstration of competency and maintaining of the acquired skills is required for compliance with regulatory agencies. Transcranial magnetic stimulation is one example of a specialized device with specific training requirements. Its not yet known how FDA will regulate trainings for psychedelic-assisted therapies.

The FDA may approve MDMA for PTSD treatment as early as2021, as MAPS has projected based on an optimistic (and likely realistic)finding of significant and positive results from two on-going Phase 3 trials.If so, thousands of therapists and doctors will be needed to meet the increaseddemand and opportunity for greater access. PTSD can be a difficult to treatcondition with many individuals not accessing or responding to availabletreatments, so this call for expanded access will be an exciting opportunity toprovide care to a much larger number of people who are currently suffering.

The next likely candidate for FDA approval after MDMA is psilocybin for the treatment of depression. In late 2018, the FDA granted Breakthrough Therapy designation for psilocybin for treatment-resistant depression, which will help expedite its approval as long as results from clinical trials remain positive

Despite many unknowns, some training programs already exist,and many more are expected to become available.

In 2015, the California Institute of Integral Studies (CIIS) started a formal training program called the Certificate in Psychedelic-assisted Therapies and Research. The hybrid residential, in-person and online curriculum is a roughly 9-month course with rotating guest lecturers and a weeklong retreat. This program is broad in focus, interdisciplinary, and covers classic psychedelic medicines (e.g., psilocybin, ayahuasca, peyote, LSD) as well as the newer medicines (sometimes labeled empathogens or entactogens) like MDMA and ketamine.

To enroll in the CIIS certificate program, interestedindividuals must fill out an application, complete an interview, and receive anoffer from the programs selection committee. Applicants are required to be alicensed mental health or medical professional, counseling attorneys, or ordainedor commissioned clergy and chaplains. The tuition cost is currently set at$10,000. There are several information sessions scheduled throughout the yearto explain more and answer questions about the program. Each cohort generallystarts in the Spring and graduates in December.

More substance-specific trainings also exist. In anticipation of Expanded Access approval, the Multidisciplinary Association for Psychedelic Studies (MAPS) has now posted an application for the MDMA Therapy Training Program with an invitation to apply. Training is currently prioritized for providers who would likely qualify for the Expanded Access program. If accepted by FDA, more clinics will open for MDMA-assisted psychotherapy for PTSD treatment during expanded access. Requirements for clinics and providers are provided as is a forum for providers to connect with others who are interested in starting up MDMA clinics.

While no strict criteria have been released about who would qualify, the MAPS website states that at minimum one person in the therapy team pair must be licensed to conduct psychotherapy. While the other person does not need to be licensed, they must display training in therapeutic relationship, ethics, and traumas.

Each clinic also needs a Drug Enforcement Administration (DEA) license, which requires a licensed medical provider who can prescribe (e.g., medical doctor (MD), doctor of osteopathy (DO), or other eligible prescriber). MAPS encourages interested providers to apply now in preparation for the expected post-FDA approval. The cost for training and supervision is currently set at $9,000.

Other industry drug sponsors, such as Usona Institute and COMPASS Pathways, and researchers at various universities have devised their own trainings and ways to prepare clinicians to work on clinical trials of psychedelics. At this time, there are no details posted on websites about what the trainings consist of, but journal publications have described procedures, such as the Usona Guide Manual [2].

The CIIS program is approximately 180 hours and covers awider range of topics related to psychedelic therapies. More time is spent onhistorical and philosophical aspects of non-ordinary states of consciousness,including non-substance induced ones as seen in Holotropic Breathwork and deepmeditation. The learning objectives are focused more broadly on psychedelicsand empathogens, rather than specifically on MDMA-assisted psychotherapy [3].

The MAPS program is a 5-part course with didactic training and experiential learning components. Trainees start with online e-learning modules covering MDMA pharmacology and its clinical safety profile, an introduction to the MDMA Treatment Manual [4], and some basics about clinical trials. A week-long, in-person training follows where MDMA session videos are viewed and discussed with the therapists who treated the study participants. The next parts involve role playing, observing MDMA sessions, and then treating a patient with supervision and evaluation from the trainers.

Some parts of these two programs overlap significantly. For example, the weeklong in-person retreat for both programs focuses on MDMA-assisted psychotherapy and are taught by Michael and Anne Mithoefer, MDMA study therapists and lead instructors at MAPS.

Dating back to the first research studies of LSD in the1950s, a first-hand experience in a non-ordinary state of consciousness hasbeen perceived valuable for administering psychedelics. Its thought that byunderstanding the drug effects, the therapists can more readily establishempathetic rapport and presence to support a persons therapeutic process. Theycan also be better able to respect the power and significance of theseexperiences.

For indigenous communities, its deemed essential thatshamans or ceremonial leaders have personal experience with the psychoactive plantsthey give to others. But in Western medical practices, it is rarely the case thatdoctors are encouraged (or even allowed) to take a medication to understand theeffects a patient would feel.

Thus, psychedelics present a new challenge for psychiatricmedical training. If there is value in having a personal experience, then howcan providers legally pursue an experiential learning component to theirtraining? To date the evidence of potential benefits of doing so remainanecdotal due to lack of approved controlled research.

CIISs program is an above board program with no use of illicit substances. MAPS, however, received approval in their sponsored, FDA-approved study that allows trainees in their program to receive one dose of MDMA in a clinical setting if they also are eligible for the research study as a participant. As with all clinical trials, participants in the approved study must meet criteria to enroll and provide data to assess potential benefits or harms. Even if they meet the basic inclusion criteria, trainees are not required to undergo an MDMA session. Some might have conditions that would counter-indicate the use of MDMA. For example, pregnant women or individuals with cardiac disease would be excluded. Trainees may also simply not want to take a drug.

As alluded to earlier, Holotropic Breathwork is one alternative to reach a non-ordinary state of consciousness without consuming any substance. Through accelerated breathing and stimulating music, a person can enter into states similar to ones induced by drugs.

CIIS incorporates Holotropic Breathwork as experiential learning in their program. Therapists may consider alternatives, but they should do so while considering carefully the legal and ethical guidelines of their licensing board and professional organizations. Psychedelic Support and its partners do not encourage or condone the illegal use of substances.

Given this reality, other possible alternatives for experiential learning do exist. They include attending plant medicine ceremonies in other countries where it is legal, shamanic drumming/chanting practices, or extended meditation. Research is needed to understand if first-hand exposure by therapists impacts patient outcomes, and if so, what type of drugs or experiences are best for training. We encourage therapists exploring this new area to consult with their colleagues and even seek out legal counsel as they deem appropriate.

If becoming a psychedelic therapist is of interest to you, then there are things you can do now to help figure out if this path is right for you and if so, prepare for the future. You can start by reading books and articles about psychedelic-assisted therapies. If you want hands-on experience supporting individuals undergoing a difficult psychedelic experience, one great way to do so is to volunteer for harm reduction services at festivals.

Already a health provider? Network with other professionals interested in this topic and attend psychedelic conferences. If you are a clinician, consider joining a Psychedelic 101 and 102 Introductory Course by Psychedelic Support providers, Dr. Elizabeth Neilson and Dr. Ingmar Gorman. Check out our website Psychedelic.Support to view a current list of organizations offering professional trainings related to psychedelics.

Lastly, educate yourself and share what you are learning with others. A new profession is evolving, and more opportunities are becoming available for those who wish to pursue a career in psychedelic medicine.

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How to Become a Psychedelic Therapist - Training Opportunities