May 27, 2022
L. Alison McInnes, MD, MS
As people learn more about psychedelic-assisted psychotherapy (PAT), I often get the question, ‘Should a clinician have a personal experience with a psychedelic before they can provide psychedelic-assisted psychotherapy to patients?’
I founded and directed a regional ketamine therapy program for depression at Kaiser Permanente that included a group ketamine-assisted psychotherapy (KAP) component 7 years ago, and then continued to do KAP in private practice after I left. Informed by this experience, I’ve lectured about KAP in a variety of PAT forums and have repeatedly heard some fellow clinicians insist that an ‘experiential session’ is an essential part of PAT training.
So, should a clinician who wants to practice PAT partake of the psychedelic medicine in question with an experienced clinician sitter to better understand their future patients who will receive the same psychedelic treatment? In responding to this question, I’m referring specifically to ketamine, which is currently the only legal psychedelic treatment available to patients. However, it can be expected this question will also be asked in the future about other psychedelics, once they are approved for medical use and become available on the market.
Some people in the emerging psychedelics field even go so far as to say that a psychedelic experience should be mandated before a clinician can receive their training certificate. However, the ‘mandate’ perspective isn’t realistic or wise. For one, among the general population, there are many medical conditions, including mental health conditions, for which ketamine is contraindicated. Any aspiring clinician could potentially also have those conditions, which would prevent them from having an experiential session.
Should we really compel a training candidate to disclose their medical history, if they needed to obtain an exemption from a psychedelic experience mandate? The experiential stipulation or mandate is insensitive at best, but it may also be illegal. I attended a forum hosted by lawyers invited to speak about real cases at the annual conference of The American Society of Ketamine Physicians, Psychotherapists, and Practitioners last year. The lawyers noted it is illegal to discriminate against hiring a KAP therapist because they had not taken ketamine.
I also worry that a one-time exposure to a psychedelic such as ketamine may lead to a narrowed view of the treatment, rather than an expanded understanding of the medicine’s effects. A KAP therapist candidate who experiences only a few (or zero) side effects after a limited number of ketamine exposures may be less likely to systematically assess side effects in a patient.
Another argument against a mandated ketamine experience is the fact that, historically, doctors usually don’t take the vast majority of medicines they prescribe for their patients. Instead, doctors and clinicians gain knowledge of the benefits and side effects of particular medicines through reading extensive research literature, combined with years of practical experience while observing patients.
The new psychedelic medicines, with the exception of racemic ketamine, will go through the FDA like any other prescription drug before coming to the market. Why should the administration of these drugs require the clinician to ingest them when no other drugs have this requirement? Moreover, what published evidence is there that shows the experience of taking ketamine makes one a better KAP therapist?
In the absence of this evidence, some period of clinician-trainee supervision by an experienced KAP therapist could be a reasonable training requirement for a certificate program. Prior clinical experience with treatment-resistant depression on the part of the clinician candidate might also lead to better results for the patient.
If a clinician chooses to practice PAT, they will likely be asked by their patients if they have also taken the drug in question. Let’s think about the intent of this question. I think the patient is really asking, “Do you know what you are doing?” or “Will you be able to understand my experience?” I believe that we do not require a supervised psychedelic experience to reassure patients about our empathy and competency. However, I also support those clinicians who feel that such an experience will make them better therapists. I support the freedom to choose.
About Dr. Alison McInnes
Dr. Alison McInnes is Vice President, Medical Affairs at Osmind, the leading ketamine EHR. She is a nationally recognized expert in psychiatry and mood and anxiety disorders, having specialized in treating refractory disease for over a decade. She is an expert in ketamine treatment and psychedelic medicine. McInnes founded and served as Medical Director for Kaiser Permanente's ketamine infusion therapy program for a number of years, and was previously an Associate Professor of Psychiatry at Mount Sinai School of Medicine for 8 years where she ran a lab in psychiatric genetics. She was also an adjunct clinical professor at UCSF.
Dr. McInnes is regularly invited to speak at national and international conferences and consults for biopharmaceutical companies working at the cutting edge of neuropsychiatry. She is a member of the American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3) Certification Governance Commission, which is an autonomous governing body that oversees the development, implementation, and management of a certification program for clinicians offering ketamine therapy. In her current clinical practice, she focuses on treatment-resistant mood disorders and complex cases.
Dr. McInnes received Bachelor’s and Master’s degrees from Stanford University and her MD from Columbia University. She completed her residency at UCSF and research at the VA Research Fellowship and Howard Hughes Physician Research Fellowship in Psychiatric Genetics at UCSF.
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