Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice.

Aja Molinar,Ingmar Gorman,Jonathan Sabbagh,Ksenia Cassidy,Elizabeth M Nielson

doi:10.3389/fpsyg.2021.645246

Aja Molinar, Ingmar Gorman + Show 3 more

Open Access

https://doi.org/10.3389/fpsyg.2021.645246

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Abstract

Psychedelic Harm Reduction and Integration (PHRI) is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented.

Highlights

Psychedelic means mind-manifesting, and is a broad term applied to compounds and experiences with related subjective effects of an altered perception of one’s sense of self and an increased awareness of mental processes
Psychedelic Harm Reduction and Integration (PHRI) incorporates elements of psychedelic-assisted therapy, Mindfulness-based therapies, relational psychodynamic approaches, and IHRP to create a framework for working with patients who present either in the decision-making process prior to psychedelic use or afterward for assistance from a clinician
The PHRI model offers a departure from abstinencebased approaches to working with people who use psychedelics, enriches the therapeutic process by offering new perspectives on the decision making and meaning-making processes, and acknowledges and works with the variety of relationships patients have to psychedelics, from harmful to fully beneficial

Summary

INTRODUCTION

Psychedelic means mind-manifesting, and is a broad term applied to compounds and experiences with related subjective effects of an altered perception of one’s sense of self and an increased awareness of mental processes. Psychedelic experiences have been referred to as NOSCs. In addition to drawing on harm reduction psychotherapy as an approach to working with people who use drugs, PHRI draws on mindfulness-based interventions, psychodynamic therapy, and psychedelic-assisted therapy for understanding and integrating NOSCs in clinical practice. The therapist must inquire about the nature of the patient’s motivations Whether they reflect an interest in spiritual growth, symptom reduction, enhancement of wellness, or a desire to enhance creativity, knowing the context and how the patient is going to use psychedelics will shape treatment and is vital for appropriate clinical care. When providing PHRI, it is paramount to work within the professional scope of one’s practice It is appropriate and necessary for a therapist trained in substance use treatment to talk to the patient about the dangers of certain drugs and drug-use-related practices in the context of reducing drug harm. It should be noted that recommendations made by therapists should be symptom- or context-specific, or in other words, tailored to the patient’s problems and concerns

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