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Overview of Requisites for Psychedelic-Assisted Therapy Facilitators

Overview of Requisites for Psychedelic-Assisted Therapy Facilitators By Dr. Michael Hofrath

Psychedelic-assisted therapy is a vast and complex landscape. Despite extensive previous and current research in this field it is still in its infancy. Even an experienced psychedelic-assisted facilitator and integration specialist there is still so much to learn. We only know what we know, we don’t know what we don’t know, and we don’t know how much we don’t know. As such a plethora of new and on-going research continues to offer new insights and understandings. In this discussion my intention is to offer a general overview of requisites, based upon my own experiential and lived experience, I feel are important for psychedelic-assisted facilitators.

Both plant-based and synthetic psychedelic medicines embody a living spirit. It is imperative psychedelic-assisted therapy facilitators respect the inherent sacredness of these mind-altering medicines and their transformative power, not take them for granted, or become lackadaisical while working with them. Psychedelic-assisted therapy sessions require a facilitators complete, and unencumbered attention, throughout the duration of the treatment.

Unlike the therapeutic process in which therapists typically lead the discourse and/ or guide the dialogue, a psychedelic-assisted facilitator, the key word being “assisted”, need to hold the tension of opposites, let go of the reins, and allow the medicine to direct the individuals journey. The adage ‘less is more’ holds true to form when working with psychedelic medicines in both dosage and facilitator intervention. Facilitators must possess a certain degree of intuitive intelligence and trust their intuition and instincts unequivocally. Presence and being conscientious of one’s voice and behavior are vital as well. Speaking incessantly to fill silent space, making excessive noise, talking on the phone, leaving the ringer on, tapping on a keyboard, aggressive or premature deep inquiry can disrupt and sidetrack an individual’s journey in a blink of an eye.

Additionally, facilitators need to understand and be aware of the inner healing intelligence of the body ‘soma’. Body and mind, psyche, and soul, have the capacity to heal given the right container, circumstances, and environment. Soma’s inner healing intelligence blossoms in nourishing, safe, and sacred contained environments. Plants are analogous to the inner healing capacity of the body. Plants have an innate wisdom and intelligence. They know how to grow, thrive, and blossom all on their own if provided with a safe, nourishing environment. Plants root systems allow them to take in nutrients and water from the soil. Leaves absorb energy from sunlight and the carbon dioxide in the air, which initiates the process of photosynthesis, and transforms these two ingredients into food in undisturbed environments. Much like plants, body and mind have their own inner healing energy and capacity and must be respected and nurtured as such.

Safety and trust are imperative. A facilitators responsibility begins long before a medicine session begins. Facilitators must understand the vital importance of assisting individuals in feeling safe. This can be accomplished in numerous ways. For instance, a discussion with the client regarding all the medical protocols in place is invaluable. This also

means it would be wise for facilitators to possess, or gain, a certain degree of medical emergency knowledge and training. At minimum a current CPR and first aid certification are a must have. Facilitators should have a blood pressure cuff, oximeter, thermometer, and it doesn’t hurt to have oxygen canisters on hand. Nonviolent crisis intervention certification and any first responder training are a huge plus as well.

Medical knowledge and tools are powerful gauges for where a client is in their medicine journey. For instance, blood pressure can reveal when a client is anxious, fearful, processing a traumatic memory (s), show when they are over activated or emotionally flooded and even when they are peaking. Additionally, allowing potential clients the ability to ask any and all questions, and being able to answer those questions adequately is paramount to earn a client’s trust. My facilitation session protocol includes a presentation, covering all vital areas and concerns, including how the individual can expect to feel while on the medicine and in an altered state, boundaries around touch, termination of session and the power of witness and holding loving space to name a few.

Regarding holding space, a psychedelic-assisted facilitator must possess the ability to “hold space” with an open heart, compassion, empathy, and non-judgment. Conversely, facilitators must have a working knowledge of transference and countertransference and be aware if this is occurring during the medicine session. Facilitators must know how to address such issues, while conveying steadfast confidence in their knowledge, skill set and verbally express their capacity to handle any situation that may arise.

The term ‘set and setting’ are bandied about often, but what exactly does this term mean? Much thought must go into creating a private, safe, contained space (temenos) that is inviting, warm and comfortable. The room (container) shouldn’t be too small that the participant feels claustrophobic, or too large that the client doesn’t feel properly contained. The set and setting should be in a temperature controlled, enclosed space to ensure comfortability and privacy with easy access to restrooms and preferably access to nature. Facilitators should have a strong understanding of how to shift ‘stuck’ energy and be able to assist individuals in the processing, integration, release, and dissipation of negative shadow components and stuck energy. Q’ero shamans and curanderos are masters of intuitively understanding energy and how to shift it. Nature is another master at shifting energy through the four elementals of wind, water, fire, and earth. Outdoor access provides a powerful grounding vehicle to anchor individuals and assist in shifting stuck energy. Access to nature and the option to escort clients outside can quickly and efficiently help shift a client’s energy.

Detailed preparation is key. Facilitators must possess strong planning and organization skills, understand how to develop, and incorporate structures/ protocols for all potential adverse events. Playing out all the various stories of all potential adverse events are all components of the planning and preparation process. For instance, making sure to stock copious amounts of water, client preferred drinks, healthy and easily digestible snacks such as hardboiled eggs, fruit, crackers, cheese, hummus, cookies, all in arms reach. The session environment should contain plentiful pillows and extra blankets. It is not overkill to stock spare socks, sweatpants, sweatshirts, T-shirts and even have a bucket on hand.

Facilitators should have a moderate to strong understanding of somatic science and somatic practices. Understanding of somatic modalities to assist clients in feeling safe in their body is vital. The ability to connect clients to their five senses, interoception, can offer a sense of safety. A thorough understanding of breathwork is also important. Understanding the role of breathwork to assist clients in moving through anxiety and fear is paramount. Facilitators should know how to attune their breath with the client’s breath, slow down clients breathing, heart rate and blood pressure. Light touch on the shoulder or arm can be very soothing and assist individuals in self-soothing. Grounding exercises can assist participants in moving back into their bodies.

Possessing trauma-informed knowledge is key. The goal of trauma-informed care is to avoid re-traumatizing someone. Re-traumatizing refers to inadvertently recreating conditions of a persons’ previous trauma, thus causing them to relive that trauma in the present. The goal of trauma-informed care is to help people find meaning and purpose in their lives, fulfill valued roles and engage in life. Additionally, trauma informed care serves to assist clients in seeing themselves as more than their trauma (s), to help clients identify and pursue distress reduction and to exercise agency, autonomy, and self-determination through the power of choice. Trauma-informed care aims to shift away from the statement “What’s wrong with me?” to the trauma-informed question of “What is the truth about what happened, that either wounded me, made me feel unsafe, or made me feel guilt or shame”?

There are numerous trauma informed principles. The below is a short of potential trauma informed principles. They include, the promotion of trauma awareness and understanding, recognizing trauma-related symptoms and behaviors originated through adaptation to traumatic responses, view trauma in the context of an individuals’ environments, to minimize the risk of re-traumatization or replication of prior trauma dynamics, create a safe environment, identify recovery from trauma as a primary goal, support the concept of choice and autonomy, create collaborative relationships, view trauma through a socio-cultural lens, use a strengths-focused perspective to promote resilience, foster trauma-resistant skills, develop strategies to address secondary trauma, promote self-care and lastly to offer hope and the internal belief that recovery is possible.

To conclude my intention was to offer a general overview of what I believe, from my own personal experience, to be requisite knowledge to facilitate medicine sessions confidently and effectively. There are numerous other areas a facilitator should be versed in. Be curious, read the current research and read books on this revolutionary field. Lastly, get as much experiential and lived experience knowledge through your own medicine experiences, as you feel you need. I firmly believe it is unethical for a facilitator to work with a medicine they have not personally experienced.

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