Portland Psychotherapy Year in Review – 2023 

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It is that time of year when we take the opportunity to pause and reflect on where our efforts have gone. We’ve seen things we’ve worked on for years come to fruition and we’ve also started some new endeavors. It’s been an exciting and rewarding year. None of that would have been possible without the support of so many friends and colleagues and, of course, our clients that we are here to serve. We wanted to take time to express our gratitude for the support and encouragement we have received from so many this past year and to share what some of that has led to.  

Meeting the diverse needs of our community by taking OHP 

A primary focus for the past two years has been on creating the infrastructure to accept the Oregon Health Plan (OHP aka Medicaid) to serve a more diverse population. Portland Psychotherapy has also started working with a Diversity, Equity, and Inclusion (DEI) consulting firm to explore ways our organization can do more to help dismantle systemic racism and other forms of oppression. Taking OHP is our first big step toward this end, especially in terms of addressing the health disparities in our community. Our providers have also reported feeling that they find it very meaningful to be able to serve clients from a wider range of backgrounds.  

Our Trainees. This year we are very fortunate to have 5 incredibly talented trainees including Brandy Tidwell, Ph.D., Kate Degenhardt, Ph.D., Taylor Coats, MA, Ravneet Dhaliwal, MA, and Kylie Gallo, MS. This cohort has a wide range of experience and expertise, and they are taking referrals for adults, adolescents and kids who have OHP. 

Expanded Family and Child Services. Naomi Wright, Ph.D. has joined the team and brings her expertise and enthusiasm for serving families and children from infants through adolescents.  

A New Building! Growing staff (28 clinical, research, and admin staff in all now!), requires more space. We were fortunate enough to be able to purchase the building across the street from our main clinic. We still have our main building at 3700 N Williams and have added the Portland Psychotherapy Annex at 3719 N Williams. 

Expanded work in psychedelic-assisted therapy and science  

As many of you may know, for the past 2 years Portland Psychotherapy has been conducting one of the first clinical trials of psychedelics in the Pacific NW — a Phase 2 FDA clinical trial of MDMA-Assisted Therapy for Social Anxiety Disorder. Our research team includes 17 individuals who have put thousands of hours and so much heart into this study. This study is completely funded through Portland Psychotherapy’s social enterprise model, in which the profits from our income generating activities go to fund cutting-edge social science research. It’s a unique model and we all feel so honored that we’re able to be a part of such meaningful work that has the potential of having a profound impact for so many.  

In addition to our MDMA clinical trial, we are very excited to be collaborating with Beckley Psytech, part of the Beckley Foundation, for our second psychedelic-assisted therapy clinical trial. We are part of an international, multisite large-scale clinical trial examining the use of 5-MeO-DMT for Treatment Resistant Depression. We’re in the early stages of this trial and is now started as of early 2024. 

In addition to currently providing Psychedelic Harm Reduction and Integration Services, Portland Psychotherapy is also gearing up to provide MDMA-Assisted Therapy for PTSD next year. Several staff have already completed training to be MDMA-AT therapists and consultants to train other therapists in this modality. Assuming the FDA approves MDMA-AT as expected by late 2024, we plan to be one of the first clinics in Portland to provide this service. We’re excited! 

Anxiety Clinic – New book and new staff 

Two Anxiety Clinic members, Brian Thomspon, PhD and Brian Pilecki, PhD have written a fantastic new book on ACT-Informed Exposure Therapy published by New Harbinger. In addition, our former postdoc, Jason Feinberg, Ph.D., now joins our Anxiety Specialty Clinic as a licensed psychologist, providing specialized treatment for adolescents and adults struggling with OCD, GAD, Panic, and other anxiety-related difficulties.  

Publications from Portland Psychotherapy staff in the past year

You can find more details and links to articles on our publication page (names in bold are Portland Psychotherapy authors)

Carroll, J. J., Rossi, S. L., Vetrova, M. V., Blokhina, E., Sereda, Y., Lioznov, D., Luoma, J.B., Kiriazova, T., & Lunze, K. (2023). The impacts of COVID-19 on structural inequities faced by people living with HIV who inject drugs: A qualitative study in St. Petersburg, Russia. International Journal of Drug Policy. 

Joseph, V. W., Moniz-Lewis, D. I. K., Richards, D. K., Pearson, M. R., Luoma, J. B., & Witkiewitz, K. (2023). Internalized Stigma among Justice-Involved Women in Substance Use Disorder Treatment: Measurement Invariance and Changes During Treatment. Stigma and Health. 

Luoma, J., Rossi, S. L., Sereda, Y., Pavlov, N., Toussova, O., Vetrova, M. V., … & Lunze, K. (2023). An Acceptance-Based, Intersectional Stigma Coping Intervention for People with HIV Who Inject Drugs–an Open-Label RCT in St. Petersburg, Russia. The Lancet Regional Health – Europe. 

Lear, M. K., Spata, A., Tittler, M. V., Fishbein, J. N., Arch, J. J., & Luoma, J. B. (In Press). Transparency and Reproducibility in the Journal of Contextual Behavioral Science: An Audit Study. Journal of Contextual Behavioral Science.  

Moore, K. E., Johnson, J., Luoma, J. B., Taxman, F., Pack, R., Corrigan, P., Hart, J., & Slone, D. (in press). A multi-level intervention to reduce the stigma of substance use and criminal involvement: A pilot feasibility trial protocol. Health and Justice.  

Tittler, M.V., Luoma, J.B., Wade, N.G., & Wei, M. (In Press). Effects of a White privilege framing and a test of moderators. Current Psychology.  

Thompson, B. L. (2023). Is ACT-informed exposure a viable treatment for excoriation disorder? A multiple baseline study. Behavior Modification. 

Thompson, B. L., Pilecki, B. C., & Chan, J. C. (2023). ACT-Informed Exposure for Anxiety: Creating Effective, Innovative, and Values-Based Exposures Using Acceptance and Commitment Therapy. New Harbinger Publications. 

Looking to the Future  

As we look back on this year it is with profound gratitude for the meaningful work, we continue to be able to do and for your support, in all its forms, that has enabled us to continue to fulfill our mission. We also look to the future, for new possibilities it may hold for our community and our world. 

There’s no Shame in Having OCD – Addressing Shame in OCD Treatment

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Shame is all too common among people with obsessive-compulsive disorder (OCD). Almost every person who I have worked with has expressed feeling ashamed and embarrassed about the content of their intrusive thoughts or the nature of the compulsions they engage in to combat them. This has been true for my clients whether they have been struggling with obsessions about contamination, self-harm, relationships, or something else. A common question I hear is “Why can’t I do X, Y, or Z like a ‘normal person’?” Along with such questions usually comes a barrage of self-critical thoughts like, “I’m such a weirdo” or “I’m so weak for repeatedly giving in to my intrusive thoughts.” In addition, it certainly doesn’t help to hear friends, family, and strangers – even if unintentionally – belittle your struggle when they talk about “being so OCD” as if this were a punchline.

Hopefully you are already well aware that highly effective, evidence-based treatments for OCD exist (e.g., Exposure and Response Prevention, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy)and are provided by our expert clinicians in the Portland Psychotherapy Anxiety Clinic. A lesser known component of these treatments is that they often involve an explicit focus on developing skills to more effectively respond to shame and self-criticism. Below are two examples of how evidence-based OCD treatments might address shame and self-criticism related to OCD, including links to helpful resources.

ADDRESSING SHAME VIA ENHANCING SELF-COMPASSION

People, including individuals with OCD, are often naturally skillful at acting compassionately towards others. However, it can be much harder to turn that compassion inwards. Therapeutic approaches to enhancing self-compassion include learning about self-compassion, understanding how it operates in your own life, and developing a consistent self-compassion routine via practicing self-compassion-focused exercises. To learn more about self-compassion and to see example exercises, use the following links:

ADDRESSING SHAME VIA COMBATING OCD STIGMA & MISINFORMATION

The reality is that most people’s understanding of OCD is limited to media caricatures they have seen of people who are highly perfectionistic and/or extremely focused on cleanliness. One of the most common initial tasks of OCD treatment is to dispel common myths about OCD and provide more factual information. Whenever possible, I like to incorporate individuals’ main support systems in this “de-mystifying OCD” process. It becomes easier to feel less ashamed about OCD when you and the people around you understand OCD and feel like you’re on the same team in treating it. For folks who encounter OCD-related stigma especially frequently, treatment may also involve learning and rehearsing ways to practice self-advocacy. Lastly, people often find it helpful to develop a sense of community in order to feel less isolated and alone in their struggles with OCD. To learn more about OCD and to see example exercises and resources, use the following links:

https://iocdf.org/about-ocd/

https://iocdf.org/realocd/

https://iocdf.org/programs/conferences/

New Insights into Psychologists’ Views on Psychedelic Therapy 

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As interest grows among both clinicians and the public, psychedelic knowledge and reduced stigma within the psychology field will be critical to ensuring these treatments are implemented ethically, safely, and accessibly. Outreach, education, and interdisciplinary collaboration remain key priorities moving forward. 

A recent survey-study involving researchers at Portland Psychotherapy provides intriguing insights into psychologists’ attitudes toward the emerging use of psychedelics like psilocybin and MDMA in psychotherapy. The study, published in the Journal of Psychoactive Drugs, found psychologists hold cautiously optimistic views about the promise of psychedelic-assisted therapy but also harbor concerns about safety risks. 

Led by Jason Luoma, PhD and Brian Pilecki, PhD of Portland Psychotherapy, the survey queried 366 licensed psychologists in the U.S. Using vignettes of client scenarios, the researchers examined psychologists’ openness to exploring psychedelic experiences therapeutically compared to alternative interventions like meditation retreats. 

Overall, most psychologists indicated receptiveness to discussing psychedelic experiences compassionately in therapy to foster learning. However, around 75% said they would likely warn clients about potential risks of psychedelic use, whereas only 25% would issue cautions around spiritual retreats. Many also expressed the need to consult colleagues due to limited knowledge of psychedelics. 

In ratings of treatment acceptability, psychologists viewed psychedelic-assisted therapy much less favorably than conventional medication-assisted treatment for opioid use disorder. They also saw greater risks and lower confidence in effectiveness with psychedelics compared to established interventions. 

Additionally, participants rated psychedelics as equivalently safe to alcohol and far riskier than cannabis. In truth, research shows psychedelics like psilocybin have very low rates of harm, in contrast to the extensive public health burden of alcohol. This highlights an urgent need to educate psychologists on the actual safety profiles and therapeutic mechanisms of psychedelics. 

On a positive note, most participants believed controlled psychedelic use in research is safe and merits continued scientific investigation. Over 80% felt research on psychedelics should continue to be researched. Still, less than half agreed psychedelics show promise for mental illness, signaling cautious optimism. 

In interpreting their findings, the Portland Psychotherapy researchers emphasized the influential role psychologists have in healthcare settings and policy. As interest grows among both clinicians and the public, psychedelic knowledge and reduced stigma within the psychology field will be critical to ensuring these treatments are implemented ethically, safely, and accessibly. Outreach, education, and interdisciplinary collaboration remain key priorities moving forward. 

Though this initial survey faced limitations like possible sampling bias, it provides a springboard to track evolving psychedelic perceptions among mental health professionals. Replication with psychologists and other providers will paint a clearer picture of where additional training and open dialogue are needed to overcome enduring misconceptions. As Luoma summarizes, “We must continue the complex process of safely integrating psychedelics into science and society.” 

Mitigating Risks in Psychedelic Integration Therapy: Practical Considerations 

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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. 

New Research Sheds Light on How Self-Criticism Damages Social Relationships 

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The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness. 

A team of researchers from Portland Psychotherapy recently published an intriguing study that sheds light on how self-criticism can damage social relationships. Self-criticism, defined as the tendency to negatively and harshly evaluate oneself, has been linked to poorer interpersonal functioning and social isolation. However, the specific mechanisms underlying this association have been unclear. In this new study, published in Current Psychology, the research team identified some likely interpersonal behaviors through which self-criticism exacerbates social disconnection. 

The researchers, Jason B. Luoma, PhD and Christina Chwyl surveyed over 300 participants from the community. They measured self-criticism along with three interpersonal variables – expressive suppression, expression of positive emotions, and self-concealment. Expressive suppression involves inhibiting the outward display of emotions. Self-concealment refers to the tendency to hide personal information perceived as negative or distressing. 

The results showed that higher self-criticism was associated with greater expressive suppression, less expression of positive emotions, and more self-concealment. These relationships held even after accounting for the roles of depressive symptoms and emotional intensity. Among these variables, reduced positive emotional expression had the strongest link to lower feelings of social belonging among self-critical participants. 

The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness. 

Suppressing positive emotions, in particular, may deprive self-critical people of opportunities for social connection. Expressing positive emotions promotes relationship development and maintenance. Failing to outwardly share happiness, excitement, and affection could impair self-critical individuals’ ability to form close bonds. This intriguing study thus highlights the importance of fostering positive emotional expression for self-critical people’s social wellbeing. 

As the researchers note, their cross-sectional design precludes firm causal conclusions. Experimental and longitudinal research is needed to further test the study’s model. However, these results move our understanding forward by pinpointing specific interpersonal pathways that may fuel the isolating effects of self-criticism. 

The findings suggest that psychotherapies which help clients express emotions openly, authentically share about themselves, and connect with positive emotions could aid self-critical individuals in building fulfilling social relationships. By targeting key interpersonal behaviors, clinicians may be able to alleviate self-critical people’s loneliness and foster a greater sense of belonging. Remediating deficits in positive emotional expression seems particularly promising based on this study. Overall, these insights enhance our grasp of how self-criticism operates interpersonally and point toward avenues for reducing its detrimental social impacts. 

What Makes Us Unique

Portland Psychotherapy is a clinic, research & training center with a unique business model that funds scientific research. This results in a team of therapists who are exceptionally well-trained and knowledgeable about their areas of specialty.