1. Practitioner Skills, Competencies & Commitments

• Humility.
• Non-judgemental attitude.
• Work only with medicines you have training with.
• You must only use the medicine(s) that was agreed upon. In no case ever is it appropriate to say “trust me” and not disclose the medicine(s).
• It is not appropriate to take any medicine if you are the practitioner during a therapy session. Your obligation is to provide a safe therapeutic container for your client/patient.
• Be familiar with the medicine you are working with. It is important for you to be intimately versed in the psychedelic landscape you are guiding people through. 
• Stay within your area of competence. 
• Do not work with medicines that you have not experienced yourself.
• Ensure that you understand the pharmacology and all contraindications for that particular medicine.
• Work within a lineage of mentorship, apprenticeship and training.
• Meet with other practitioners to mentor and share best practices.
• Recognize the lineages associated with the medicines you are working with, especially if they have an Indigenous history.
  ‍It is important to be aware of the traditions of Indigenous and ceremonial use associated with particular medicines.
• Appreciate both the strengths and limitations of your approaches, scope and framework. Understand that there is no ultimate framework for psychedelic-assisted therapy. There are many different approaches to this work and appreciating where your framework falls short is just as important as understanding where it can be most effective.
• Be a lifelong learner: continuously learn and upgrade your knowledge. There are always more tools you can add to your toolbox and being a good psychedelic practitioner means continuously sharpening your own tools. Continue to train in your modality to stay informed of current evidence and practices.

2. Client / Participant Selection‍

• Avoid entering into dual relationships as they are likely to lead to impaired professional judgement or exploitation (A dual relationship is when you have two or more distinct kinds of relationships with the same person. This means having a relationship within the individual that is outside of the established therapeutic context, for example, where the individual is also a relative, friend, coworker, or part of your social group).  
• In cases where there is an unavoidable dual relationship i.e. working in a very small community: give special attention to issues of confidentiality, trust, communication, and boundaries. Seek supervision as needed.
• Fully explain your treatment modality.
• Fully disclose your training level.
• Conduct thorough screening for contraindications - medical, psychological, and contextual. If psychedelic-assisted therapy is not recommended, make appropriate referrals for alternative treatment if possible. 
• Ensure medicine is a good choice for your client.
• Do a psychological review to ensure it is safe to proceed with this session.
• Fully discuss fees - what is included; what is not included.
• Fully explain how termination of treatment will be handled.
• Ensure that each client is eligible–medically and psychologically–for a psychedelic session(s) and has a supportive environment to return to afterwards. 
• Conduct fulsome preparation for the session.
• Complete all required consent forms and waivers.
• Clearly explain both the risks and benefits of using psychedelic medicines.
• Do not make unrealistic claims about what may occur.
• Clearly address misinformation and dispel myths.
• Supply evidence-informed information and clearly disclose if there is a lack of evidence.
• Emphasize confidentiality and how it will be protected.
• Ensure clear communication and comprehension of topics discussed with your client/patient.
• Have a thorough and ongoing consent process. Make this a clear part of your practice from the start and understand that you are responsible for informing individuals of any legal limits to confidentiality prior to obtaining personal information or providing service. 
• Recognize and respect that each client has their own lived experiences as well as worldviews, values, and beliefs that may influence how ‘meaning-making’ occurs. 
• Clearly identify your own biases and issues.
• Understand how to therapeutically deal with projection, transference, and countertransference
• Discuss clearly the goals and motivations of therapy for the client.
• Ensure an integration plan has been established either with yourself, an integration group, another practitioner, or at the very least supportive friends and family.
• Ensure post-therapy support is in place - friends, family, community.
• Refer out to other practitioners when you feel your experience and training level might not be a suitable match for a potential client.

3. Proper Consent for Session

• Basic effects of the medicine.
• Subjective effects.
• Physiological effects.
• Mechanism of action. 
• Expected benefits.
• Expected risks.
• Expected duration.
• Expected intensity.
• Potential side effects (common to rare).
• Contraindications.
• Alternative options for treatment.
• Medications’ or supplements’ interactions.
• Your therapeutic modalities.
• Thorough discussion around touch - including physical or energetic modalities.
• Supports during the session, including logistics such as walking to the bathroom.
• Other safety considerations: e.g. an agreement to stay on site for the duration of the session, emergency contacts, what would happen in case of emergency.
• Termination of sessions.

4. Preparing your mind and body

• Ensure you continue to strengthen your own foundations of health and wellness.
• Practice grounding.
• Lean in to your triggers and learn from them.
• Ensure that you are working with safe and effective medicines.
• Ensure clients know how to ascertain the purity and safety of medicines via medicine testing services.
• Make sure your preparatory materials are catered specifically to the medicine that you will be working with. 
• Avoid generalized advice and preparation. Be specific to the medicine.
• Continue to train in cultural sensitivity.
• Continue to train in trauma-informed modalities
• Practice self-care and self-awareness, including your individual willingness to recognize and address projection, transference, and countertransference issues.
• Try not to take on too much. Recognize when your own energy levels are depleting. 
• Do not take on clients at the expense of your own physical or mental health.

5. Expectations and intentions

• Manage the expectations of your client.
• Lean into challenging experiences.
• Articulate what therapeutic modalities will be used.
• Have a consent process for touch - physical and energetic modalities.
• Describe potential post-session challenges: insomnia, anxiety, disorientation, depression.
• Include the participant in all decisions regarding the session(s), and follow up post-session(s).  
• Schedule at least two preparation sessions with a client.
• Ensure that you have met with your client in person ahead of their medicine session so that you can develop rapport and trust.
• Create a ‘materials checklist’ for yourself so that you do not forget anything on the day of the medicine session.
• Bring fresh food and snacks for after the medicine session.
• Ask your client if they would like any portion of their session audio recorded.

6. Medicine Session

• Be a calm, abiding presence to what is unfolding rather than directive. 
• Ensure a safe and comfortable setting free from outside distractions.
• Work within a dyad or group whenever possible.
• Reassure the client that their own inner healer will help guide the session.
• Reassure the client that you will keep them safe at all times and that you are there to support them regardless of what unfolds.
• Remind the client that once they have taken the medicine, they must stay in the session space until you both agree that it is safe for them to leave.
• Recognize that individuals have different cultural and religious beliefs, and allow their own ‘meaning-making’ to take place.
• If working in close proximity to others (i.e. neighbours), give them a heads-up that vocalizations or loud noises may occur.
• Ensure all materials that you need are present and within close reach.
• Take note of any important observations that arise.

7. Post Session Care

• Ensure that the client will be returning home to a safe and supportive environment. 
• Verify that they have arranged someone to pick them up and drop them off. They could be impaired after the session and safety is paramount.
• Have an emergency response plan, including friends or family to contact.
• Make sure that the client has an integration plan in place.
• Check in with the client within the next day or so.
• Give your client space to process their experience.
  

8. Integration

• If you give a medicine you are fully responsible for engaging with integration as long as necessary. If you are not the primary person providing integration, you are responsible to ensure care is bridged between the medicine session and the client’s current therapist or an integration circle.
• Support client to create a re-entry plan including:
  • Self-regulation tools
  • Rest and recuperation
  • Meaning making

• Find opportunities to discuss unmet expectations and challenging experiences.
• Bring to the client’s awareness the potential somatic manifestations.
• Propose supportive bodywork including massage, osteopathy, etc.
• Encourage creative activities - journalling, music, art, collage, poetry.
• Suggest movement therapy.
• Recommend exercise.
• Underscore the importance of healthy eating.
• Describe and explore how others can support the client (friends & family).
• Provide information on group integration circles and psychedelic communities in their area they can participate in.
  

9. Termination of Therapy

• Use clear communication on how you will terminate therapy.
• If termination of therapy is due to ruptured therapeutic alliance, give the client a list of potential resources.

10. Community & Accountability

• Connect with local psychedelic communities. Being a part of psychedelic communities allows people to be aware of the work that you are offering, and it helps to bring this work to the people who need it.
• Create accountability in your practice. If you work in a group already, then focus on setting aside time to check in regularly with your colleagues. 
• If you work alone, find at least one accountability partner with whom you can keep connected to on a regular basis to discuss cases and red flags.

11. Access for All

• Consider how you will give back to the community so that those without resources can access therapy.
• Consider a sliding scale.
• Consider a scholarship fund.
• Introduce a donation model into your practice at some level. Ask clients who are well-resourced if they would consider donating to a scholarship fund that will help offset the costs of treatment for someone who can’t afford it.  
• Ask medicine sellers to donate 10% of profits to non-profits that provide therapy.

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Suggested Resources, Inspirations for this Collaborative Document and others’ work we have borrowed from:

Association of Spiritual Integrity. (2022). ASI Honor Code of Ethics and Good Practice for Individuals. Retrieved Feb 23, 2023 from https://www.spiritual-integrity.org/ethics/

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Association of Entheogenic Practitioners. (2022). Code of Ethics. Retrieved Feb 23, 2023 from https://www.aep.community/ethics

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Conclave, The. (2019). 5-MEO-DMT A Recommended Model for Best Practices. Retrieved Feb 23, 2023 from https://cdn.prod.website-files.com/5dab753665b2d985ff08d69b/5dab753665b2d92d7808d6d1_Best%20Practices%20Outline%20(Finalv9).pdf

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Conclave, The. (2019). The Conclave Ethical Commitments. Retrieved Feb 23, from https://cdn.prod.website-files.com/5dab753665b2d985ff08d69b/5dab753665b2d9a3bd08d6e9_Conclave_Ethical%20Commitments.v.1.4.pdf

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Conclave, The. (n.d.). Commitments and Agreements. Retrieved Feb 23, 2023 from https://theconclave.info/

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Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Frontiers in Psychology, 12, 645246–645246. https://doi.org/10.3389/fpsyg.2021.645246

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Guild of Guides (n.d.). Code of Conduct. Retrieved Dec 15, 2022 from

https://www.guildofguides.nl/code-of-conduct/#content

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KRIYA Institute. (2020). Ethical Guidelines for Ketamine Clinicians. Retrieved Feb 23, from www.kriyainstitute.com/guidelines

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Multidisciplinary Association of Psychedelic Studies. (2019). MAPS MDMA-Assisted Therapy Code of Ethics. Retrieved Feb 23, 2023 from https://maps.org/news/bulletin/maps-mdma-assisted-psychotherapy-code-of-ethics-spring-2019/

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Robertson, J. (2019) What Makes a Good Psychedelic Guide. Retrieved Feb 23, 2023 from

https://mapsofthemind.com/2019/12/24/what-makes-a-good-psychedelic-guide/

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Rochester, J., Vallely, A., Grof, P., Williams, M. T., Chang, H., & Caldwell, K. (2022). Entheogens and psychedelics in Canada: Proposal for a new paradigm. Canadian Psychology = Psychologie Canadienne, 63(3), 413–430. https://doi.org/10.1037/cap0000285

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THE PSYCHEDELIC ASSOCIATION OF CANADA WOULD LIKE TO THANK THE FOLLOWING INDIVIDUALS FOR WORKING ON THIS DOCUMENT:

Michelle Gagnon

Pamela Kryskow

Lorraine Percey

Michelle Brewer

Tracy Lowe

Editors of document: 

Michael Oliver