Psychedelic HRIT is an emerging clinical area that requires careful consideration of risks associated with this type of therapy. Although it can be a powerful tool for mental health treatment, clinicians must be aware of the potential for licensing board sanctions, criminal prosecution, malpractice litigation, and professional reputation damage.
Psychedelic therapy has gained increasing attention as a potential treatment for a range of mental health conditions, from depression to PTSD. Along with this comes the need for harm reduction and integration therapy (HRIT) to help individuals navigate their psychedelic experiences safely and effectively. However, there are risks associated with conducting this type of therapy, particularly in regions where it is still illegal. In this blog post, we will outline some of the most common types of risk associated with psychedelic HRIT and suggest steps clinicians can take to mitigate these risks.
One of the most significant areas of risk for clinicians offering psychedelic HRIT are licensing boards. Although clinicians may not be engaging in any illegal behavior, licensing boards have a broader mandate to assess professional conduct and determine if a clinician is acting outside the boundaries of acceptable practice. Licensing boards may receive complaints from clients, other clinicians, or members of the public, particularly in areas where psychedelic therapy is stigmatized. A client’s family or another provider may discover that a therapist is offering HRIT and perceive that the therapist has encouraged the client to use illegal substances, which could trigger a complaint. In addition, licensing boards may consider it a violation to engage in intention setting or other strategies aimed at maximizing benefit as they may be perceived as encouraging clients to engage in illegal activities.
Another area of risk is criminal prosecution. If a therapist wants to do the maximum to avoid risk, they should avoid facilitating access to prohibited substances in any way and refrain from providing a space in which psychedelics could be used. Referring clients to underground guides or assisting them in the attainment of prohibited drugs is a clear violation of the law and could implicate a clinician in racketeering, conspiracy to commit a crime, or aiding and abetting unlawful acts.
Malpractice litigation is another potential risk associated with psychedelic HRIT. If a client is harmed during a psychedelic experience, a therapist may be sued for failing to protect the client from harm, especially if psychedelic HRIT is considered a new treatment that lacks scientific evidence. Violation of standards of care could also be argued if a therapist does not take a more conventional approach to treatment. Practicing in any new or less proven area of practice will necessarily increase your liability and HRIT is no exception.
Professional reputation is also an area of risk for clinicians offering psychedelic HRIT, particularly in more conservative regions or traditional therapeutic contexts. If clinicians perceive that publicizing their HRIT services might jeopardize their income or employment, it may limit the accessibility of this type of therapy for the public. Agencies may not support or permit this type of practice, and clinicians must be aware of these risks. It’s best to consider how your agency, your locale, and your colleagues might react before you offer this type of therapy.
Mitigating these risks includes many possible steps, such as avoiding facilitating access to prohibited substances in any way, whether it be by referring clients to websites to obtain illegal substances or by providing a space in which psychedelics could be used. It is also important to carefully consider language used in advertising and documentation to ensure clarity and reduce the probability of misperceiving HRIT therapy as involving the administration of psychedelic substances. Clinicians should expand their competency by obtaining adequate training and access to consultation resources, and they should become familiar with empirical support for psychedelic-assisted therapy, including both strengths and limitations. Understanding the science and being able to speak from an informed, balanced, and evidence-based perspective demonstrates sound ethical practice.
Psychedelic HRIT is an emerging clinical area that requires careful consideration of risks associated with this type of therapy. Although it can be a powerful tool for mental health treatment, clinicians must be aware of the potential for licensing board sanctions, criminal prosecution, malpractice litigation, and professional reputation damage. By avoiding facilitating access to prohibited substances, carefully considering language used in advertising and documentation, expanding competency through training and consultation resources, and becoming familiar with empirical support for psychedelic-assisted therapy, clinicians can mitigate risks and provide a valuable service to their clients. If you want to learn more about the ethical and legal aspects of working with psychedelics as a therapist before widespread legalization, you can read more at this paper that researchers at Portland Psychotherapy wrote that is a result of months of work and consultation.