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All About Psychedelic-Assisted Psychotherapy

January 19, 2023
Photo of Lindsay Billingsley, clinical counsellor and registered social worker

Psychedelics regularly make headlines these days. Celebrities like Aaron Rodgers and Prince Harry have publicly discussed their experiences with ayahuasca and magic mushrooms. As attitudes towards psychedelics improve and legislative changes unfold, use of these powerful compounds for mental health treatments like psychotherapy is growing in popularity.

But what exactly is psychedelic-assisted psychotherapy (PAP) and how does it work? PAP is a therapeutic practice which involves the ingesting of psychedelic substances. It has shown promise for treating conditions like addiction, depression, and end of life distress. At Filament Health, we provide natural psilocybin for emergency PAP in Canada via the Special Access Program, and hope to supply the newly-opened Oregon therapeutic market in the near future.

To learn more, we spoke to Lindsay Billingsley, a clinical counsellor and registered social worker who provides PAP:

1. To begin, can you explain in layman’s terms what psychedelic-assisted psychotherapy is?

One way to look at psychedelic assisted therapy is to see it as regular counselling or a therapeutic treatment modality that (think CBT or DBT), when and where indicated, could be augmented by the judicious use of psychedelic medicine.

2. What can a prospective patient expect the treatment process to look like? Can you describe dosing, timing, and other elements of the experience?

A key factor in creating a meaningful medicine experience is preparation; you can think of this like an intake and assessment process, exploring the patterns of a person’s lifetime with the goals of fostering a reasonable level of comfort and understanding of the medicine experience, creating an intention for the medicine experience, and creating authentic connection and care between therapist and client, which will allow the client to surrender more fully to the medicine experience. 

On average, the day of the medicine experience can last anywhere from 6-8 hours. The day begins with creating a safe and intentional space that marks the transition from the everyday, to something more ceremonial in nature. This can be done in a variety of ways that align with the beliefs and comfort level of the client, but which often include an altar where folks can place meaningful objects, photographs, and where we will have fresh flowers and a candle to mark the passing of time. Intentions from both client and therapists would be spoken aloud and gratitude would be offered to the medicine and those who have paved the way to allow us to be receiving this opportunity at this time.

The client is offered the medicine and is invited to lie down with the eye shades, to meditate, or perhaps do some breathing to assist in managing any anxiety that may be arising. The therapists are there to assist with anything that may come up, to ensure your physical safety and attend to any other needs throughout the experience, ensuring that you will be accompanied by someone at all times.

Dosing is typically between 3.5 to 5 grams as the intention is to facilitate a mystical type of experience. The arc of the medicine is a 20-40 minute onset, followed by a peak at approximately 60-90 minutes, with a gradual decrease in intensity over 4-6 hours. Clients can expect to feel the effects in a softer form for the rest of the day and therapists should make themselves available through the night and next day to provide support if necessary. 

Once the medicine day is complete the work of integration begins. I cannot overemphasize the importance of integration, without working to anchor the insights and teachings gathered from the medicine into the here and now, a medicine experience will fade over time and can be just another peak experience that we humans tend to be drawn to. While it may seem to some that psychedelics are a magic pill, the reality is that healing requires effort and a commitment to meeting whatever may arise and working through it. The process of integration unfolds over time and is well supported by service providers who specialize in this field. 

3. How did you become interested in psychedelics and what led you to pursue this career?

Working as a social worker and clinical counsellor for the last 17 years, I have witnessed firsthand the revolving door of substance use and mental health. Our services are understaffed and overburdened, and so often the answer for the many who are struggling is anti-depressants and try harder. Through my own personal journey with meditation and embodied practices, I had an experience that revealed how our bodies hold so much more than talk therapy alone can access, prompting me to shift my focus away from the typical clinical training into more somatic based modalities. During that time I became aware of the research that was documenting incredible results for the very populations of people I had spent my career walking alongside and I knew immediately that this was a field I needed to explore. In 2019 I applied to CIIS’s Certificate in Psychedelic Assisted Therapies and Research and have been an advocate and ardent supporter of the field ever since.

4. What is it about psychedelics that you think is so powerful in helping people?

In my opinion psychedelics do two things really well - first, they bring people back into connection with themselves, back into connection with trusting that they have the answers and know what to do in order to heal. This creates empowered, confident human beings who can stand solidly in their own powerful sense of self. The second part is that they facilitate deeply authentic and powerful bonds between client and therapist in a very short amount of time. In therapy it is the relationship between client and therapist that is the best predictor of outcomes but one can spend years in developing the kind of bond that will allow you to take off your mask and risk being seen for who you really are. Psychedelics appear to fast track this process and allow for expedited access to this level of therapeutic relationship.

5. You recently participated in a clinical trial where you took Filament’s natural psilocybin drug candidate - can you tell us about that experience?

Of course! This clinical was an incredibly important milestone for the psychedelic community because it allowed health professionals to have a personal experience with psilocybin in a legal context, which has been extremely difficult, if not mostly impossible, up until now. The trial was beautifully facilitated by the folks at ATMA, who created a safe and supported space in which folks were able to have their personal experiences and also learn how to hold this sacred container in a way that may be quite different from their formal training. The medicine was offered in small groups within the same room, the music being played out loud rather than in headphones, allowing participants to truly “feel” the musical in a visceral way. The group was comprised of a variety of professionals, some of whom had never had any experience with psychedelics, and it was clear by the reports in the integration circles that the majority of folks had deeply meaningful experiences.

6. Do you think there’s a benefit to natural psilocybin over synthetic?

It certainly makes sense to me that there are additional benefits to natural over synthetic; my mind goes to eating fruit and all the fibre that is missed when we don’t eat the skin, not to mention all the current research on various types of fungi that are indicating the many possible health benefits contained therein.

7. What do you think is the biggest barrier to more people accessing psychedelic-assisted therapy (and the associated benefits)?

Stigma perpetrated by the war on drugs; it was one of the most successful smear campaigns of all time and we are still dealing with the effects of it.  Although many of the “facts” that we have been fed over the last several decades were not based on the scientific evidence available at the time and even though we have robust evidence in support of the safety of many of these so called “harmful drugs”, many folks have a hard time unwinding themselves from what they learned growing up and are fearful of the possible negative consequences they believe may befall them should they choose to use these substances.

8. How would someone become a psychedelic-assisted therapist? What is the training like?

I think it makes sense that if someone wants to offer “therapy” then they should be training first as a therapist. My suggestion is to become a competent therapist who has a variety of tools to offer clients, gaining experience in the ordinary realms of consciousness, prior to adding non-ordinary states to their list of offerings. That being said, there are many incredible practitioners of energy, body work and non registered therapists who have been practicing in the psychedelic space for decades and whom I hope will also have a role in the psychedelic space of the future as we look to create a spectrum of services that is as inclusive and diverse as the people we serve.

There are a variety of programs available at the post-graduate level that focus solely on the aspects that are specific to psychedelic assisted therapy, programs like Vancouver Island University’s Certificate in Psychedelic Studies, which is similar to the well established program offered by the California Institute of Integral Studies in San Francisco; similar programs are being developed privately as well and are being offered by organizations like Therapsil, ATMA, and MAPS. These programs are often a hybrid of online and in person intensive style learning, and the cohort is made up of multiple disciplines including nurses, social workers, doctors, psychologists, and ordained clergy, offering a rich and diverse learning environment. Some trainings are substance specific, like MAPS, but they will usually cover everything from the history of psychedelics, to drug interactions and mechanism of action of the substances used, set and setting of a therapy session, integration of the medicine experience, screening and intake, and how to ensure that we are creating safe spaces for all people to be able to access these transformative medicines in our communities.

9. Is there any advice you’d give to someone looking to get into your field?

Do your personal work, dig deep into the corners of your own psyche and commit to “know thyself” - psychedelic assisted therapy takes us deep into the psyche, into different realms of consciousness that defy explanation using the rational “thinking” mind, and yet are no less “real” to the experiencer, the better you know those landscapes, the more supportive and useful you will be as a therapist. 

The other piece is that this work is not to be done in isolation, we all have blind spots and none of us can be an expert in every possible field. Whether you are on a traditional “team” or not, build connections within and across the spectrum of service providers who are out there, have a solid referral network to support your client with whatever may arise, and ensure you have others to support you in your work. Mentors are essential and should be a part of your practice from the time you enter into the helping profession until the day you decide to retire, they provide light in times of darkness and keep our egos in check when we think we have arrived at this place on our own.