Sage Institute: A Model for Accessible Psychedelic Therapy and Training
As psychedelic medicine enters the mainstream, moving towards legalization, commercialization, and greater public acceptance, some important questions arise: Who will have access to these treatments? How will the treatments be taught and used as they propagate? How will financial interests and new technologies impact the way these medicines are used?
While the answers to these questions are not yet clear, we can imagine the psychedelic movement taking a direction that excludes many, dilutes the richness and profundity of the work, uses technology in the place of human contact, and makes use of psychedelics to accumulate profit. The online graphic novel “We Will Call It Pala” (aurynproject.org/pala) depicts one such future unfolding. In response to the daunting potential outcomes, Sage Institute has created a model that offers an alternative: a clinic which is financially accessible, values the representation of diverse identities in the hiring of staff and interns, holds the work in an ethical and equitable way, and is run without the influence of financial interest or material gain; one that makes use of technology only so far as it supports greater access and affordability, without sacrificing the essential and human elements of this work.
The Sage Institute Model
Sage Institute is a non-profit organization founded in 2019 by a group of therapists interested in furthering the psychedelic psychotherapy movement by: (1) increasing accessibility for underserved communities, (2) training the next generation of psychedelic therapists from diverse backgrounds by experts in the field, and (3) helping to build the body of research on the efficacy and safety of psychedelic therapy for diverse populations. Our mission is to provide high-quality training and sliding-scale psychedelic-assisted psychotherapy, fostering culturally-responsive treatment for underserved communities in the Bay Area. Sage Institute offers ketamine-assisted therapy and plans to offer other psychedelic-assisted treatments as they become legal.
To facilitate accessibility, we use the widely accepted model of a training center with a sliding scale community mental health clinic, allowing us to drastically reduce the cost of treatment. We will also offer groups to facilitate accessible services and to build community. Beyond limited financial resources, there are a range of additional barriers to accessing psychedelic psychotherapy in the communities we serve. These are discussed extensively in “Blinded by the White: Power & Privilege in Psychedelic Medicine” (on chacruna.net), and include unstable housing, lack of community support, inadequate or mis-information about psychedelics, a lack of diversity amongst therapists trained in psychedelic work, systemic racism, and lack of cultural humility. We are working to address access on all levels. We proactively recruit intern therapists who reflect the cultural backgrounds of the communities we serve, diversifying the ecosystem of trained psychedelic psychotherapists and creating unique relational and engagement opportunities to encourage marginalized communities to participate and remain in mental health treatment. We partner with other organizations that provide complimentary services to create a safety net and are developing a robust program of community offerings, groups, and educational activities.
We hold depth and relational psychotherapy, trauma-informed care, social justice, and liberation psychology as theoretical frameworks to inform our training model. Rigorous engagement with depth psychotherapy provides interns with a dynamic theoretical lens for engaging the images, visions, symbols, synchronicities, and other expressions of the deep psyche arising within psychedelic spaces. Our trauma-informed approach aims to help clients feel an established sense of safety with providers through unconditional empathy, titration of intense affective states through careful attention to nervous system arousal and coregulation, attunement to dissociation, and engagement with dissociated self-states. We support our practitioners in addressing acute, developmental, and cultural trauma as well as systems of oppression affecting the wellbeing of our clients and communities. We use an intersectional lens to explore complex issues surrounding accessibility, power and privilege, cultural sensitivity to indigenous origins of psychedelic medicines, and reflections on the incorporation of indigenous wisdom in the face of colonization and cultural appropriation.
Sage Institute is committed to helping build the body of research investigating psychedelic psychotherapy, with particular attention to actively engaging the communities we serve through a participatory action research framework and developing culturally responsive treatment protocols aimed to support marginalized groups such as communities of color, LGBTQIA+, gender non-conforming and non-binary, and beyond. The goals of our research program are to (1) collect quantitative and qualitative data for use in ongoing, high-level research assessing the efficacy of ketamine-assisted psychotherapy and other psychedelic treatments as they become legal; (2) partner with other key players in the field to promote the advancement of psychedelic medicine; and (3) measure outcomes in order to assess safety and efficacy and for purposes of program monitoring. Our research outcomes can then be used to encourage insurance companies to cover these treatments.
Sage Institute operates on a core set of values. These values guide our work at the micro (individual), mezzo (community) and macro (system) levels we seek to impact. They include:
- Health and Wellbeing: supporting health and wellbeing within the communities we serve
- Access: increasing access to the most effective, client-centered forms of mental health treatment
- Ethical Practice: commitment to upholding the work in a way that centers the safety and autonomy of the people we serve and the integrity of medicines we use
- Competence: ensuring the competence of the therapists we train through rigorous training, thorough evaluation, and immersion in time-tested practices and traditions
- Diversity: valuing and centering diverse voices
- Inclusion: centering those who have been historically excluded from the conversation
- Cultural Responsivity: adapting the work to the communities we serve
- Healing Through Relationships: centering the therapeutic alliance, built on trust and safety
- Community: supporting a sense of connection through community building
- Harm Reduction: meeting people where they are at on their path of growth, and finding tailored ways to help them reach their self-defined goals
- Education: increasing public knowledge about the safe medical use of psychedelics
- Integration: placing special attention on the integration of psychedelic experiences as an integral part of the process of healing
- Commitment to Personal Growth: engaging in our own healing work, knowing our limits, seeking help when needed, and developing our knowledge of the medicines we work with
- Accountability: holding each other accountable within a community of psychedelic practitioners, offering support, skill development, guidance, and feedback
Our Response to Commercialization
In the face of the impending commercialization of psychedelics, Sage Institute hopes to offer a counterpoint to soaring costs, profiteering, exclusivity, and the dehumanization and de-souling of psychedelic medicine. For-profit, investor-funded corporations are driven by pressure to meet the requirements and revenue expectations of their investors often at the expense of the populations they serve; community wellbeing becomes a lower priority. We are committed to implementing strategies to steer the psychedelic movement away from profit-driven models towards public benefit. As a nonprofit organization, Sage Institute is aimed at uplifting the communities we serve without concern for the financial gain of owners or investors. Our services are intended to increase access to effective mental health treatments, reduce health disparities by addressing social determinants of health, and improve mental health outcomes.
A major concern within the psychedelic community is that the work will be diverted, distorted and diluted by the new generation of relatively naive and inexperienced people entering the field. We are building an ethical framework for the medical use of psychedelics that prioritizes quality of care, efficacy, ethical practices, relational safety, and honoring traditional practices. While our model offers a structure for reducing the cost of psychedelic psychotherapy, we are committed to upholding a high standard of service alongside lower fees. To ensure the quality of our services, we prioritize rigorous training of our therapists by experts in the field, thoughtful and discerning gatekeeping involving thorough evaluation by supervisory staff, and thoroughly vetted safety protocols and quality assurance mechanisms.
Our training supports intern therapists in developing a solid grounding in foundational clinical skills, and careful attention to the basic tenets of psychedelic work regarding set and setting, preparation, and integration. We situate psychedelic psychotherapy as a relational modality, where the potential benefits from both psychedelics and psychotherapy are catalyzed by the quality of the relationship between therapist and client. Our intern therapists undergo a rigorous and multi-step evaluation process to demonstrate their readiness to begin ketamine-assisted therapy. Psychedelics are used as a tool only when deemed appropriate by the practitioner team through an extensive assessment of the client’s symptoms, needs, history, expressed treatment goals, support structure, and level of readiness. Although we hope to shape this movement with new and creative ideas, we are aware of the need to work within already established healthcare systems. We borrow vital quality assurance mechanisms for the safe use of medicines in tandem with psychotherapy, and plan to build new models and safety mechanisms that are specific to the uniqueness of the psychedelic field.
The commercialization of psychedelic medicines, when motivated by profit, is at risk of promoting a competitive atmosphere amongst businesses in the field. To support an attitude of collaboration and mutual support as we explore these new terrains together, we value an open praxis approach as delineated in the Statement on Open Science for Psychedelic Medicines and Practices (chacruna.net). We plan to develop a manual describing our operational model that we will make available, along with our outcome data, to assist others in developing similar programs and propagate like-minded research projects. In doing so, we hope to support the proliferation of low-fee psychedelic clinics in communities across the country and the collective effort to legitimize psychedelic psychotherapy. It is critical that we work from a social justice lens in order to develop a model that has a far reach and is replicable within diverse communities.
Implementation of Our Model
To open our doors and begin offering sliding scale psychotherapy services, we gathered volunteers who are passionate about our mission to make up our interns, faculty and staff. Our staff and interns offered their time in-kind for the first several months of operation, and our faculty are volunteering their time for our first year of operation. Intern therapists see clients at a reduced rate in exchange for intensive training and supervision culminating in hours towards clinical licensure, and a certificate from our training institute showing two years of dedication and experience in psychedelic psychotherapy. By gathering volunteers, we have been able to run on a very lean operating budget for our first year in order to launch the program. Though this was an effective strategy to open our doors, we value not only creating accessible treatments but also developing a model that is sustainable for therapists and staff.
Sage Institute is currently one of very few clinics nationwide offering long-term lower-fee psychedelic-assisted therapy, and demand is high. Our waitlist is currently several months long. There has been notable interest in our services coming from BIPOC and LGBTQIA+ communities. It is critical that we grow our capacity, and we will do so annually by bringing on new cohorts of therapists; we anticipate doubling in size in our second year of operation as we recruit a second cohort of intern therapists to begin in the Fall of 2020. It is even more critical that we carefully build a replicable model of quality, accessible care.
We plan to move towards greater sustainability of our organization through the development of additional programming including public educational events and a certificate program for licensed providers that are offered for a fee. We have received significant interest from practitioners seeking training in psychedelic-assisted therapy. These programs will help us to further our mission by educating and building the capacity of therapists and healthcare providers across the country to provide psychedelic therapies in their communities in a sensitive, ethical, and socially just way.
Access to affordable and effective mental health treatment is a longstanding problem within our healthcare systems. Recent research suggests that psychedelic psychotherapy has the potential to accelerate and improve mental health outcomes. In the upcoming months, we aim to develop our research and education efforts, demonstrating the validity of these therapies in order to move them further towards prioritization by funders, donors and the general population. In building the credibility of these treatments, we hope to inspire interest in collaboration with healthcare, educational, and insurance systems to further our efforts towards greater accessibility.
A Call to Action
We opened our doors in September of 2019 and could not have imagined the impact this organization would have on all of our lives and the lives of our clients and communities. We love our work, and get regular reminders of the life-changing impact it is having on the people we serve. After completing a ketamine-assisted therapy treatment with one of our talented therapists at Sage Institute, one client noted:
“I feel like it’s made a huge difference in my life. I had been struggling with PTSD and depression for a long time and despite therapy and learning tools to improve I wasn’t able to implement them because I was so focused on just surviving while constantly on edge. Ketamine therapy and my work with [my therapist] gave me the boost I needed to be able to get past surviving and focus on really improving everyday...[My therapist] helped me to process everything, and made it feel like a safe environment, which is something I’ve had trouble feeling in other therapy settings...During the ketamine sessions I was able to think about things that normally would overwhelm me, without experiencing the intense body anxiety I would normally feel. That really helped me to reprogram how I thought about my trauma.”
Though our work is both in demand and effective, we are not able to cover our overhead with our client revenue alone. Until we can implement the steps delineated above towards greater financial sustainability, fundraising through grants, donations, and other opportunities is essential. With many donors in the psychedelic movement focused on legalization and decriminalization, and as a new and small organization hoping to help shape the direction of the field as psychedelics become legal, we have yet to secure major sources of funding. As we continue our efforts to make quality psychedelic therapy equitable and accessible, we need to cultivate new networks of support and we ask for your help in doing so.
It is essential that we work together to promote an ethical approach to psychedelic medicine as early as possible in this renaissance of the movement. To do so we are focusing our efforts on building the capacity of diverse therapists to do this work in a sensitive, compassionate, and competent way while simultaneously increasing access to these treatments. Reducing costs and expanding the diversity of therapists in the field will encourage the engagement of marginalized people typically left out of the conversation. We hope that our values and training model will help to disseminate cultural awareness throughout the psychedelic community and shift the popular “magic pill” mentality towards one that views the therapeutic relationship as central to healing. We will continue to educate and bring together healthcare, education, and funding stakeholders to collaboratively invest in and bring forward this work in a way that positively impacts our communities. We hope to inspire and support other clinics across the country to put equity, accessibility, and quality of care over profit.
Genesee Herzberg, Psy.D., is a licensed psychologist practicing in Berkeley, CA. She obtained her doctorate in clinical psychology from the California Institute of Integral Studies, where she was awarded the Kranzke scholarship for her research on the phenomenology and sequelae of MDMA-assisted psychotherapy. In June of 2018, Dr. Herzberg co-founded Sage Integrative Health, a holistic health and psychedelic psychotherapy clinic in Berkeley that offers ketamine-assisted therapy and has applied to offer MDMA-assisted psychotherapy through an Expanded Access program. In 2019, she co-founded and currently serves as executive director for Sage Institute, a sliding scale ketamine-assisted therapy and community mental health clinic in Oakland. Dr. Herzberg is also a therapist and sub-investigator for MAPS’ MDMA-assisted psychotherapy for PTSD research. She is passionate about increasing the accessibility of psychedelic medicine and supporting the field in moving towards greater inclusivity of diverse and traditionally marginalized voices. She has published several articles on these topics.
Heather Valdez, L.C.S.W., is a licensed clinical social worker and nonprofit development consultant based in Oakland and Berkeley, CA. She is co-founder and board member of Sage Institute, a nonprofit organization focusing on increasing accessibility of psychedelic-assisted therapies. She is a psychotherapist at Sage Integrative Health, a clinic with a holistic approach to wellness, where she offers Ketamine-Assisted Therapy. She is also a trainee in the MDMA-Assisted Therapy Training Program through MAPS in anticipation of Expanded Access approval. Heather is social justice-oriented and passionate about working to improve mental health outcomes for LGBTQIA+ populations and communities of color, both of which she identifies with. She has extensive experience in this area via program development, fund development, committee consultation, training, and managing clinical case management programs. She values working to uplift un/underserved and marginalized communities by working to ensure access to healthcare and other vital services to promote equity, equality, and well-being.
Sage Institute website: www.sageinst.org