Supervision & Mentoring Archives

What MFTs Need to Know

I just finished teaching a six-month training for Marriage and Family Therapists (MFTs) on Psychedelic-Informed Care, in collaboration with Sacramento Valley CAMFT. These trainings are needed for a simple reason: increasingly, the topic of psychedelics comes up in therapy sessions. Should I do it? Would it help? What are the risks? Can you help me think this through? This is why psychedelic-informed care for MFTs matters.

The fact is that, with a few exceptions, therapists are not trained to answer these questions. If psychedelics are discussed at all, it is usually in a psychopharmacology class as “drugs.” Very few programs address their healing potential, and even fewer teach clinicians how to work skillfully with clients who are curious about them, considering them, or trying to integrate an experience afterward.

As a result, many MFTs are clinically, ethically, and legally underprepared. We may feel curious, nervous, excited, skeptical, or unsure. And yet, the client is already there. Invited or uninvited, psychedelics are finding their way into the therapy hour.

This is why MFTs need to learn Psychedelic-Informed Care (PIC).

To be clear, PIC is not psychedelic-assisted therapy (PAT). PAT refers to clinical work that includes administering a psychedelic substance within a legal, medical, or research structure.

Psychedelics may also come up through underground ceremonies, psychedelic tourism, ketamine clinics, religious practice, or solo use. Regardless of where the client’s interest originates, PIC provides licensed clinicians with tools to discuss, educate, reduce harm, clarify motivation and risk, and support integration, while respecting self-determination and avoiding the encouragement of illegal behavior.

In brief, PIC helps therapists help clients think clearly, make informed decisions, and integrate psychedelic experiences while remaining ethically and legally grounded.

Base Camp, Not Sherpa ¹

A useful metaphor for the MFT’s role is that of the Sherpa and the base camp. The Sherpa helps the client climb the mountain. That is not our role. Our job is not to dose, source, guide, or facilitate the psychedelic session. We are base camp: a stable place where clients can prepare thoughtfully, assess risk honestly, and return when the experience needs integration, or if something goes wrong.

This is not a small role. Clients do not need us to be enthusiastic cheerleaders or frightened gatekeepers. An acronym I developed to explain this is that PIC therapists listen to WCIG. We must be:

Warm enough that clients tell the truth.
Curious enough not to impose our agenda.
Informed enough not to minimize risk.
Grounded enough not to cross legal or ethical boundaries.

Some questions clients often ask:

“Should I Do It?”

When a client asks whether they should use a psychedelic, the temptation is to answer too quickly. But underneath one question, there are often deeper ones: Can you help me? Will you reject me? Can you hold my uncertainty? Aware of the power differential, we must be careful not to lead the client in either direction. Instead, we can welcome the conversation without judgment and help them explore their assumptions, alternatives, motivations, and risks.

“What Are the Risks?”

MFTs do not need to become physicians, pharmacologists, or attorneys to be helpful. Still, we need enough literacy to know when something may be risky and when to consult or refer. Clinician and educator Kristina Hunter offers a useful concept here: the three mirrors: body, mind, and life context.

The body: medical issues, medications, substance interactions, cardiac concerns, pregnancy, neurological factors.

The mind: history of psychosis, mania, severe dissociation, suicidality, or current crisis. Is the client sufficiently resourced to handle intense material?

The life context: housing stability, relational support, time to recover. Or isolation, impulsivity, secrecy, and the hope that one experience will fix everything.

We should not medically clear clients or encourage use, even if we think it might help. We are helping them think more honestly and, when warranted, inviting them to discuss medical concerns with a qualified professional. And although we should not tell clients what to do, it is part of our duty of care to name our clinical concerns.

“Can You Assist Me?”

A client may ask for our involvement in many ways: “I’d feel safer if you were there.” “Can you talk to the underground guide?” “Can you help me figure out how much to take?” These requests may express attachment needs, fear, hope, or trust and should be explored rather than dismissed. But they also require boundaries.

We must clearly separate preparation and harm reduction, exploring intention, expectations, support systems, and aftercare, from facilitation, dose coaching, procurement, or participation in an unregulated session. The latter falls outside our role and can move dangerously close to ethical and legal transgressions. Being clear about this protects the client, the therapist, and the profession.

The Morning After

Clients may show up the following week and report that they used psychedelics over the weekend and now want, or desperately need, to process the experience. When things go well, they return inspired, tender, and full of insights to propel therapy forward. Other times they return confused, inflated, ashamed, or dysregulated. “I saw God.” “I think I remembered a trauma.” “I haven’t slept for two days.”

Integration is not about forcing the experience into a neat clinical interpretation. It is the slow, vital process of helping raw experience become embodied, relational, and livable, turning psychedelic states into psychological traits.

Sometimes this means supporting meaning-making. Other times, it means grounding or assessing whether consultation, psychiatric evaluation, or medical intervention is required. This is not always easy. Separating a spiritual emergency from a psychotic break requires real care and expertise. Psychedelics do not exempt us from ordinary duty-of-care responsibilities. Safety always comes first. Do not hesitate to reach out for support when needed.

Why PIC Matters for MFTs

MFTs understand relationships, systems, attachment, trauma, and the complicated ways people change and resist change. Psychedelic experiences may open doors, but clients still have to walk through them in real life, with partners, children, parents, and responsibilities.

Every therapist working in this area should be able to say clearly what they do and do not do. Our role is to provide PIC, not PAT: to help clients explore motivations, risks, expectations, meaning, and integration, while avoiding providing, recommending, sourcing, or facilitating psychedelic use.

The psychedelic landscape is changing quickly. Laws differ by jurisdiction, research findings keep emerging, and public enthusiasm often outpaces regulation and training. We need more than opinions. We need ethical steadiness, clinical humility, and a robust consultation network. Part of our role is to help clients separate hype from reality.

As I have said elsewhere, even for experienced guides, psychedelics are terra incognita. Old maps used to warn us that there may be dragons out there. Psychedelics can be powerful, healing, destabilizing, and sacred, sometimes all at once. We need to be prepared.

Psychedelics do not make therapy irrelevant or outdated. They can amplify our impact on a client’s healing process. Our training gives us a reliable compass to keep clients safe within ethical and legal boundaries, helping them think, prepare, integrate, and stay connected to themselves and their relationships. By maintaining solid boundaries, we can support the client’s journey without losing our own way.

I offer talks, workshops, and consultation for MFTs, clinicians, and organizations navigating Psychedelic-Informed Care, integration, ethics, boundaries, and clinical risk.

Speaking / Workshop Inquiry

Follow the Psychedelic Series

A note on language: Sherpa refers both to an Indigenous Himalayan ethnic group and, in common usage, to a profession associated with high-altitude mountain guidance. I use the term here in the latter way, with respect and awareness of both meanings. ↩︎

Why psychedelic guides need training, humility, supervision, and ethical accountability

There is an ongoing discussion in different forums about the problem of abuse in psychedelic circles and the need to train guides better. I could not agree more.

We all need to make a solid commitment to safety, professionalism, and accountability in the field of psychedelic-assisted guiding and psychotherapy, insisting on the importance of comprehensive training for guides. It is my hope that the psychedelic community worldwide, both aboveground and underground, takes notice and keeps this conversation going.

Helping others work with expanded states of consciousness is not an easy job. I’ve been at it for over 20 years now, and I’ve seen a lot. Of course, every profession has its occupational hazards. Still, I am convinced that, due to what it attempts to achieve, being a psychedelic guide is not for the faint-hearted. Aspiring guides should take note of this.

Psychedelics can be understood as nonspecific amplifiers or catalysts that make it possible to take a journey into one’s psyche and explore otherwise inaccessible deep recesses of the unconscious. This means that they can bring whatever is hidden deep in the unconscious to the surface. As any psychotherapist can tell you, this has incredible healing potential and, conceivably, is also a recipe for disaster.

It is common knowledge that the unconscious holds all kinds of repressed and disowned material. Among other things, it includes our darkest impulses, hidden wounds, and private fantasies, often of a sexual or aggressive nature. If that were not enough, we must add archetypal and transgenerational forces dwelling in the collective unconscious.

The psychedelic guide’s job description includes the willingness and ability to work with these wild subterranean currents, operating both in the client and the guide, to facilitate healing and growth. A good guide must be able to engage not only at the mental-emotional level, but also with the body, energetic, archetypal, and spiritual dimensions of experience.

To do this, guides need more than enthusiasm. They need clinical literacy, ethical grounding, relational maturity, somatic awareness, cultural humility, and a respectful understanding of the spiritual and ceremonial traditions they may encounter. Quite an undertaking.

With such a high bar to meet, mistakes are bound to happen. In Mexico, an old proverb says: “In the soap maker’s house, everybody either falls or slips,” meaning that one should not be quick to judge others because, sooner or later, we too will make a blunder.

In a way, guiding happens at the soap maker’s house.

But how can we reduce the risk of making such mistakes? The answer is quite simple: training, training, training. Or, more specifically, learning, doing our inner work, staying humble, and getting plenty of supervision.

Being fully aware of the pitfalls of guiding, any guide training should begin by discussing ethics. Then it should continue talking about ethics throughout and end by reminding trainees again about the value of ethical behavior and their responsibilities toward clients.

When I teach, I spend time talking about transference, including erotic transference, and countertransference; working with shadow material, both the client’s and the guide’s; working with physical touch; respecting boundaries; working with childhood and attachment wounding; and appreciating the power differential in the guiding relationship. I put particular emphasis on reminding students how and why the stakes are even higher when clients are in expanded states of consciousness.

However, talking about ethics is never enough. I help students understand why these ethical principles and healthy boundaries are needed. Experience has shown that ethical principles rarely work when presented as a list of “thou shalt not.” They only function when guides internalize and commit to upholding them.

As is often pointed out, psychedelics are going through a renaissance. Among the many aspiring practitioners who want to become guides, a few always want to do it for personal, often unconscious, reasons. There is often a guru or messiah syndrome somewhere to be found, or old hidden childhood wounds crying for attention.

I see my job as an opportunity to teach them that being a guide requires profound humility, endless openness to learning, and an unwavering commitment to serve others.

As expressed earlier, being a psychedelic guide or a psychedelic-assisted psychotherapist is not for the faint-hearted. It demands standards of care, ethics, and practice well above those in many related professions. The stakes are higher, and the potential for damage, and healing, is formidable.

Let us all reiterate our pledge to continue working to become guides devoted to such standards. Let’s do it together.