MAPS Bulletin 2021: Vol. 31, No. 2
Many readers of the MAPS Bulletin will resonate with the notion that psychedelic experiences can be some of the most significant events of an individual’s life. With recent developments in research, deprioritization efforts in multiple jurisdictions, and increased attention to the potential benefits of psychedelics, there is a greater and greater need for health care providers to be educated about psychedelics to adequately serve people who’ve had such significant experiences. To answer this need, multiple entities such as professional associations, independent study programs, conferences, and a variety of continuing education programs have emerged. Yet mere availability of information cannot overcome the stigma around psychedelics and their unfortunate absence in the existing Western psychotherapeutic paradigm–an absence keenly felt by those for whom psychedelic experiences are indeed a central facet of the human experience. Fluence (fluencetraining.com) seeks to address this gap in both knowledge and practice. By developing a means to explore and integrate the nuances and insights associated with psychedelic experiences into daily life, we work to move healthcare beyond symptom reduction and toward empowering individuals in their capacity for flourishing—a process in which psychedelic-assisted psychotherapy and psychedelic integration therapy will play increasingly important roles.
Presently, the psychedelic therapy training landscape encompasses a broad spectrum of programs that:
- Train psychedelic therapists specifically for working on clinical trials
- Train therapists to work with psychedelics outside of research settings, with still-unclear legal pathways to practice
- Train clinicians to work with ketamine, incorporating psychedelic therapy orientations and legal avenues to practice ketamine-assisted psychotherapy
- Provide transtheoretical training in psychedelic harm reduction and integration which can be easily incorporated into a therapist’s or clinician’s existing practice.
Fluence is the only training organization with a psychedelic integration therapy training program where therapists can learn a peer-reviewed model for the conduct of psychedelic integration in private practice, outside of clinical trials or the administration of a psychedelic (Gorman & Nielson et al., 2021). Our Continuing Education (CE) and Continuing Medical Education (CME)-accredited programs can be taken individually or as part of more comprehensive certificate programs which serve physicians, psychologists, pharmacists, nurses, social workers, coaches, and wellness practitioners. Our offerings range from introductory workshops on the burgeoning psychedelic-assisted psychotherapy field and practice of psychedelic integration therapy, to in-depth reading groups and experiential practice retreats. Additionally, we offer ketamine training programs for providers interested in working with local ketamine clinics and/or expanding their existing private practice to include legal ketamine-assisted psychotherapy. We provide custom online classrooms, course materials, and discussion boards as part of program participation; live-online small-group classes with leading researchers in the field; and a place of connection and collaboration for our course graduates via ongoing community and networking.
Fluence also provides services to and builds relationships with a wide range of entities currently seeking to expand access to psychedelics as medicines, including drug sponsors, clinics, and independent researchers. Our active work as psychedelic therapists and trainers in research studies provides us with a valuable perspective on the quality and adoptability of current psychedelic-assisted psychotherapy protocols. Our team helps Fluence trainees apply these perspectives in their own research and practice, which in turn can contribute to the development of new psychedelic-assisted psychotherapy approaches. Most recently, we’ve partnered with Beckley Psytech to develop a 5-MeO-DMT therapy model suitable for the research setting. Fluence cultivates a reflexive approach, whereby firsthand experience as therapists and trainers continuously informs the development of more effective ways of working therapeutically with non-ordinary states of consciousness in research settings, and ultimately beyond research. As legal avenues to practice psychedelic-assisted therapies emerge from the drug development pipeline, we stand ready to translate this knowledge into accessible training programs for clinicians in the community.
The links between our training program and MAPS’ MDMA Therapy Training program are long-standing. One of the first places we (Fluence’s co-founders) connected and worked together was as participants in MAPS’ “Part D” training at Stony Point, New York, in 2017. When we started offering our own workshops on psychedelic harm reduction and integration in 2018, the MAPS training program significantly influenced our approach–particularly with respect to incorporating multiple methods of learning such as: in-person training, roleplays, autodidactic approaches, mentorship, experiential practices, artistic expression, and learning from community. MAPS’ MDMA Therapy Training Program is groundbreaking in both its breadth and depth, and we have incorporated its emphasis on learning (adopting new ideas) and unlearning (releasing old ideas) into our training as we attempt to facilitate a shift in perspective among our trainees with regard to their role as therapists and the role of psychedelics in their patients’ treatment. Both programs thus shift the concept of therapist from being someone who “provides” information, treatment, and health, to someone who creates the space and opportunity for patients to generate their own insights and become active agents in their own healing. In doing so, the two approaches and training programs honor the patient’s healing intuition and the intuition of the therapist.
Moving away from a biomedical, overly materialist, symptom-reduction model can be a challenge for therapists and for their patients. We seek to address this challenge by emphasizing the therapeutic relationship’s central role throughout our training program. In our view and experience, therapists can actively create the conditions for their patients’ insight to arise by cultivating an open, curious, non-judgmental stance to the patient’s experience, and engaging with uncertainty rather than imposing a predetermined road-map for their patient’s course of treatment. Fluence teaches the necessary skill of sitting with patients when they have not yet developed the words to describe their experience, as the territory of the unformulated is rich in therapeutic possibility and especially relevant in the context of psychedelic-assisted psychotherapy. Fluence teaches MAPS’ ethical guidelines (2021) as part of our training, and our broader mission (fluencetraining.com/mission-statement) and values reflect our commitment to diversity and inclusion in the burgeoning psychedelic-assisted psychotherapy space. At Fluence, we recognize the foundational connections between stigma, drug policy, and drug-related harms which disproportionately affect marginalized communities and communities of color. We are dedicated to addressing this through our diversity fund (fluencetraining.com/diversity-fund) and, more broadly, through consistently teaching topics such as ethics and the role of systemic inequities in healthcare. Ultimately, our goal is to provide an open, honest, and welcoming learning atmosphere in which providers can become knowledgeable about the true risks and potential benefits of psychedelics; engage in authentic, patient-centered, research-informed discussions; and offer access to the highest quality of care available.
Our vision for the future is both expansive and well-defined. First, we recognize the need for and desire to uphold consistent accreditation and credentialing standards for programs and practitioners in the psychedelic therapy landscape–especially within the context of the United States’ changing drug policies. Second, we envision a wide consortium of trainers and training programs whereby a variety of qualified leaders are involved in the establishment of said standards. Third, we see Fluence as involved in producing new peer-reviewed literature on the development and delivery of training programs for psychedelic therapy which may inform and help refine training standards. Fourth, we will continue to expand our resources to train and foster a diverse group of professionals in this field, and to grow our training offerings to cover various kinds of psychedelic-assisted psychotherapy approaches for clinical practice in accordance with regulations in a post-approval world. In this vein, we will endeavor to provide accessible and high-quality evidence-based training to clinicians at the scale needed to facilitate wider dissemination and equitable access to psychedelic therapies.
Fluence will continue to inform the blossoming of a new psychotherapeutic paradigm which effectively incorporates psychedelic experiences into the path of individual and collective healing. As an organization grounded in a bio-psycho-social-spiritual approach to human suffering and flourishing, we recognize the inherent complexity of the psychedelic experience, the human experience, and indeed the psychedelic nature of the human experience. Fluence is helping practitioners discover how psychedelic experiences may liberate and empower people to access new ways of being and how psychedelics can be marshalled to help grow more holistic, care-oriented, and sustainable relationships with ourselves, with each other, and with the wider world.
Acknowledgments: We thank Maisie Coburn and Brad Burge for their assistance in preparing this article.
Acknowledgments: We thank Maisie Coburn and Brad Burge for their assistance in preparing this article.
References
Gorman, I., Nielson, E., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic harm reduction and integration: A transtheoretical model for clinical practice. Retrieved March 10, 2021, from https://www.frontiersin.org/articles/10.3389/fpsyg.2021.645246/abstract
MAPS Public Benefit Corporation. (2021, January 7). Code of Ethics for Psychedelic Psychotherapy Version 4. Retrieved March 10, 2021, from https://cdn.mapspublicbenefit.com/wp-content/uploads/2021/02/02222746/FinalDocument_Psychedelic_Assisted_Psychotherapy_Code_of_Ethics_V4_7_January_2021_Final-1.pdf
Dr. Elizabeth Nielson is a co-founder of Fluence and a psychologist with a focus on developing psychedelic medicines as empirically supported treatments for PTSD, substance use problems, and mood disorders. Dr. Nielson is a Site Co-Principal Investigator and therapist for an FDA approved Phase 3 clinical trial of MDMA-assisted Psychotherapy for Post-Traumatic Stress Disorder, and has served as a therapist on FDA approved clinical trials of psilocybin-assisted treatment of alcohol use disorder, psilocybin-assisted treatment of treatment resistant depression, and earlier phase 2 and 3 trials of MDMA-assisted psychotherapy. Through Fluence, she provides continuing education and training programs for therapists who wish to engage in integration of psychedelic experiences in clinical settings. Her research includes qualitative and mixed-methods projects designed to further understand the phenomenology and mechanisms of change in psychedelic-assisted therapy, including the experiences of trial participants and of the therapists themselves. Having completed an NIH postdoctoral fellowship at NYU, she has published and presented on topics of psychedelic therapist training, therapists’ personal experience with psychedelics, and including psychedelic integration in group and individual psychotherapy.
Dr. Ingmar Gorman is a co-founder of Fluence, a psychedelic education company training mental health providers in psychedelic treatments. As a psychologist, he shares his expertise in empirically supported psychedelic treatments with his clients and trainees alike. Dr. Gorman received his clinical training in New York City at the New School for Social Research, Mount Sinai Beth Israel Hospital, Columbia University, and Bellevue Hospital. He completed his NIH postdoctoral fellowship at New York University. He simultaneously served as site co-principal investigator on an FDA approved Phase 3 clinical trial of MDMA-assisted Psychotherapy for Post-Traumatic Stress Disorder and is currently a study therapist on the same study, as well as another FDA approved clinical trial of psilocybin for treatment resistant depression. Dr. Gorman has published on the topics of classic psychedelics, ketamine, MDMA, and Psychedelic Harm Reduction and Integration.
