“The Emerging Lexicon of Psychedelic Therapy” is a conversation hosted by Jimmy Nguyen and Nicholas Levich on the lack of continuity among common words and phrases used to discuss psychedelic therapy, and how different interpretations can lead to different expectations.
Using their own experiences, they discuss “psychedelic therapy” as an umbrella term for guided psychedelic experience, and describe what it means to them. They analyze how context and standards help to define the specificity of therapy, and why it is so helpful to establish agreed-upon therapeutic language.
The conversation covers Jimmy and Nicholas’ interpretations of different therapeutic psychedelic approaches and treatments. They describe how psychedelic experiences vary from clinical settings to international retreats, and explain the vocabulary that surrounds each option.
Later, they explain how to take matters into your own hands by defining what therapeutic healing looks like to you. How do you navigate a landscape that hasn’t been fully paved yet? How can you name and describe the exact type of psychedelic experience that you’re looking for?
Episode 43- The Emerging Lexicon of Psychedelic Therapy
Jimmy: Welcome to The Psychedelic Passage Podcast. My name is Jimmy Nguyen, I’m joined here by my cohost Nick Levich. Thanks for joining us this week. We’re going to be talking about a topic that I hope is helpful for folks.
What Nick and I realize is with the emergence of psychedelics into the mainstream and then also this novel whole environment where new ways of engaging with psychedelics, new services. Things are becoming more legitimate, and actual services are offered, businesses are creating these services. There’s now models of psychedelic use.
We realize there’s a lot of language across the psychedelic landscape that’s used that many folks probably don’t even agree on the definition of some of these things, and therefore that’s probably pretty confusing for you, the psychedelic curious person, the psychedelic interested person.
So, today we’re going to be talking about the emerging psychedelic lexicon and our attempts of not only defining what this dynamic is like in the current stage of psychedelics but also maybe trying to lay out what some of these things mean especially-
Nick: I mean if nothing else just from our perspective.
Jimmy: Right. It’s our view of it. I guess we’ll start by just having this conversation that a lot of these components of psychedelic service are being defined right now. I wouldn’t say that there’s commonly agreed on standards, let alone language that we use. And you see this in Oregon as well, Nick?
The Discrepancies in Language & Therapeutic Expectations
[00:01:50] Nick: Yeah, I mean I’ll give folks an example. So, traditionally if you are advertising a service as therapy, that inherently means it’s being done by a licensed mental health professional. And then you look at what’s happening in Oregon where we’re in the midst of rolling out psilocybin-assisted therapy and you don’t have to be a licensed mental health professional to facilitate that.
And so, you can see how quickly just in one state things are already confusing because talk therapy you need to be licensed as a provider, but for psychedelic-assisted therapy you don’t have to have a mental health license.
And so, then you can start to get into like, “Okay, well, what’s the difference between psychotherapy versus talk therapy versus psychedelic-assisted therapy versus psilocybin assisted therapy?” You can see how quickly this turns into kind of a mess.
Jimmy: Yeah, with the protocols, let’s say for ketamine-assisted psychotherapy, it’d be the same for psilocybin or MDMA if you’re in a clinical setting or if you are looking for a clinical medical model-
But then the service provider that you get actually isn’t rooted in that background, but it’s all under this umbrella of psychedelic-assisted psychotherapy. And then also you have to disclaim if it’s massage therapy or acupuncture or other therapeutic models.
You bring up a good point that all of this has been used interchangeably and we are in an environment where that can be really confusing for folks to really figure out what they’re actually seeking and what services are actually available.
Nick: And services are very different. The problem is: how are we identifying them and how are they being positioned? And candidly we deal with this problem with running Psychedelic Passage in the sense that what most people are searching for when they’re looking for these types of services is psychedelic-assisted therapy.
But then what our network of facilitators actually provide is I would argue like not traditional therapy, but that’s what people are using to search for an intentional therapeutic ceremony.
Jimmy: Yeah, we have to be really mindful to say, “Hey, we aren’t mental health professionals.” And even with facilitators within our network who do have mental health backgrounds, they’re not serving in that capacity.
And it gets pretty interesting because you would think so– okay, if it’s psychedelic-assisted psychotherapy that must mean that mental health professionals are providing this. Oh, but by the way, there’s no licensure track for those folks to be able to do that and provide it.
I think this is just an example of just highlighting that the psychedelic landscape is really in flux right now and there are the development of these tracks and these processes. But it’s important for folks to at least be aware of this thing that we’re talking about as you’re seeking psychedelic services, just to be really clear on what folks are offering and the services that you’re looking for.
Nick: Yeah, I think I would sum it up like this. There is a distinct difference between how the service is being labeled and then what’s actually included and who facilitates it.
Because almost everything is getting lumped into this label of psychedelic-assisted therapy and sometimes there’s actual therapy included, sometimes there’s not.
Sometimes it’s with a licensed mental health professional and sometimes it’s not. And all of those are under the same umbrella currently.
Jimmy: Or somebody who has, let’s say, educational background in mental health, like a– [crosstalk]
Nick: MA Psychology degree
Jimmy: -counseling degree, something like that, but they don’t have their practicing license yet, or folks who do have their practicing license. The cool thing and I hope that there’s an umbrella of services. I hope that there are tracks and routes for anybody.
Like if I want to go down a private youth ceremonial track, I can do that. If I want to go down a more traditional talk therapy track, I can do that.
If I want to go down an art therapy track, I want to be able to do that, but, yeah, this is important, especially for folks who are using this whole umbrella term of psychedelic-assisted psychotherapy because it’s very broad right now.
And it’s really interesting because when we look at the MAPS trials and studies with MDMA, it’s the first time that a federally scheduled drug is seeking approval in the combination of therapy and so you don’t normally see that.
You normally see clinical trials of just compounds being passed for legal use. And this one is interesting because it combines both the substance and therapy associated to it. And so, they’re also trying to define that and the standards and things of that at the federal level and clinical level.
Nick: As if this already wasn’t confusing enough, we take a lot of consults with people who call in and they’re like, “So, are we doing talk therapy while I’m on mushrooms?”
Nick: They literally think that they’re doing a 6-to-8-hour therapy session while under the influence of a psychedelic, which even in the presence of a therapist, that’s most likely not how that’s going to unfold because at least from my own experience, I can barely form sentences when I’m on medium to high doses of mushrooms.
Jimmy: And it’s so substance dependent. I for damn sure wouldn’t want to do that on psilocybin, but I’m like, “Okay, a low dose of MDMA, that could be possible.”
Nick: Maybe. Right.
Jimmy: Low dose of ketamine, that could be possible. But then you got to think that’s clinic-dependent as well. The approach and the modality–[crosstalk]
Nick: Right. We see this with ketamine clinics all the time. People say, “Oh, well, I did ketamine therapy.” And then you find out there was no actual therapy. All it was was drug administration. There was no talk therapy, no prep, no integration. So, that’s also being called psychedelic-assisted therapy.
Jimmy: Yeah. I think we’ve broken down this kind of concept, this psychotherapy versus psychedelic-assisted psychotherapy versus therapeutic versus other.
Nick: [laughs] It’s all therapeutic.
Therapeutic Dosing Sessions vs. Healing Ceremonies
[00:09:02] Jimmy: And then you’re bringing up the difference. Here’s another one, this difference between dosing session versus program versus ceremony and what all of that entails. So, help our listeners break that down a little bit.
Nick: Well, I think dosing session is the most literal term for when you are actually consuming the psychedelic, and usually that’s going to be a half to full-day session.
Jimmy: Depending on the substance. In this case, we’re talking about psilocybin. If you’re looking at ketamine, that’s probably two or three hours end to end, depending again on the route.
Nick: Right. I think when we start to use a word like a program, we’re defining the full extent of the program, which might include a dosing session but may also include other elements like prep and integration as a part of the program package.
Jimmy: It might include, screening and onboarding, may go across a period of time of a couple of months or you may do it in days and weeks.
Nick: Yeah. When I think about ceremony, for me, it’s very much indicative of this moment in time where you exit different than you entered and there’s an acknowledgment of essentially a transitionary state and it’s often accompanied by more–
What I’ll call like, sacred community and/or indigenous practices. To me, when I think about ceremony, it’s something that honors the sacred and honors the ritual. It’s kind of like the other end of the spectrum for me from what I would call the clinical approach.
Jimmy: Yeah, so it’s dosing session and ceremony are likely talking about the same event, but from two very different perspectives and angles. Dosing session being very neutral and very to the point.
Jimmy: And then ceremony denotes. Yeah, I like what you said about the sacredness part of that. And, again, that depends on the tradition of the medicine keepers, that depends on the context of your use.
So, that ceremony in itself can also look really different. Like, we have many ceremonialists within our network and ceremony for each person is probably different as well.
Nick: I mean it’s different for you and I.
Jimmy: Yeah. And likely will have some of the same core components, opening up a container, creating safe space, offerings of prayer, and things like that, but everybody would approach that differently.
And so, if you’re thinking about this as a psychedelic-interested person or an explorer, just know that you do have these options and it’s our attempt to arm you with the right language and tools so that you can ask the questions so that you can know what you’re getting yourself into.
By no means are we saying that any of this is right or wrong. I’m very staunch in my stance that you have radical freedom of choice in how you engage with psychedelics. But if you walk into a ceremonial setting thinking that it’s a clinical, medical, you’re going to have a big dissonance– [crosstalk]
Nick: Or vice versa. You think you’re going to have this sacred experience and you walk into a fluorescently lit white-walled space with a doctor’s table on it, that’s a whole different vibe than a ceremonial space. And so, I view those as just like opposite ends of the same spectrum.
Nick: There’s everything in the middle, there’s retreats, there’s all kinds of stuff, but there is a spectrum in terms of how that dosing session is approached.
The Differences Between Facilitators, Practitioners, & Guides
[00:12:57] Jimmy: Yeah, let’s talk about practitioners for a little bit. There’s a lot of terms thrown around there.
Nick: Guide, facilitator, trip sitter, everybody’s neighbor is a shaman now, you know what I mean like– [crosstalk]
Nick: Provider, professional.
Jimmy: What are your thoughts around that?
Nick: Therapist. Also, very confusing. Also, no set definitions on what is what. I mean, I think internally you and I have kind of agreed upon some differentiating factors, but that does not mean that the average human out there knows, or understands the subtleties there.
I think that’s also what makes it really hard for folks that are looking for services, is you’ve got all these names for a provider and there’s very little understanding about what they mean and if any of it is actually being checked, verified, regulated, etc.
Jimmy: In addition to what we’re talking about earlier, which is the context of the services. And then you’re talking about this vetting and standards and some of those things.
I was actually talking about this earlier today. It’s really interesting. Maybe we can start with a trip sitter, guide, what we think those mean, and then why you and I landed on facilitator.
So, I’ll start with a trip sitter. I think that trip sitter is a very broad term and that is anybody who is accompanying you and looking after you in a psychedelic experience. So, this opens a world of a sober friend, family or friend who’s just there in the house.
There are some folks who will sit with you literally, and all that they’re doing is just making sure that you don’t hurt yourself or you don’t fall or you can make it to the bathroom okay, there’s trip sitters in more public settings and environments, music festivals, things like that.
But I find that a trip sitter takes a really low involvement in your process. Typically, just on the ceremony or the dosing day, but likely not a person who’s supporting in prep or integration or anything like that. Any other thoughts there on a trip sitter?
Nick: No, I think that’s a good summation.
Jimmy: That’s one end of the spectrum, and then I would go onto the far end of the spectrum, which are folks who claim, I’m saying this very specifically, folks who claim to be psychedelic guides.
And those would be folks who take a really, really, direct hands-on approach, more of like an agenda format to your experience, whether it’s the experience itself or whether it’s the structure and how to and what to do of your experience.
And so, again, I’m not saying that this is right or wrong, I just know that “guide” to me denotes some power dynamics. It just denotes some things that I think people should be thoughtful of if you’re looking for a psychedelic guide.
Nick: But, see, here’s where it gets really confusing for me because when I internally think about a guide, I’m like, “Oh, that’s someone who’s like, okay, Nick, go through the green door on the left.” Which is not and how I like to be led during a session, nor how I would ever facilitate for a client.
But that’s like the connotation that guide has for me is like tell me what to do while it’s happening. But here’s where it gets really confusing for us from a company perspective.
So, you can see how this plays out in practice is like internally we refer to our network as facilitators. And I’ll let you explain why in a second here.
Nick: I was literally having a call, we’re in the midst of a whole website rebrand overhaul right now, and one of the questions that we landed on is like, “Do we use the term guide or facilitator?”
And the problem that we’re having is we know what a facilitator means and why that’s important. But the average journeyer is actually looking for a guide. That’s what they have the mental association of what–
Jimmy: A guide to them makes more sense. Like I’m looking for a psychedelic guide and you look at a word like facilitator, which to us feels more accurate to the scope of work, but then they’re like, “What the hell is a psychedelic facilitator?”
Nick: It was interesting because I actually pulled our internal team, all of our concierges that take consult calls and I asked them how people were referring to what they were looking for and it was 80% guide.
So, interestingly enough, we’re moving towards using the word guide because that’s what people are looking for. But I actually believe the service that they’re providing is far more in line with facilitation. So, do you want to describe facilitators?
Jimmy: Sure, yeah. I’ll just highlight that this is exactly what we were talking about in the first part of the podcast, where that may be the commonly used term and you’re looking for a psychedelic guide.
And then you’ve got to realize that there’s 50 different ways of guideship and that may be different than what you might actually be looking for, which may be a trip sitter or what you might be looking for is a facilitator or a clinical– [crosstalk]
Nick: Or a therapist, maybe what you’re looking for is a therapist.
Jimmy: Exactly. So, the other thing that I want to point out as well as I talk about what a facilitator is, is that I acknowledge that people are looking for guidance. And that is different than guiding you through a psychedelic experience.
And guidance can be things around safety and harm reduction, guidance can be things around dosage or what frameworks may be applicable for me to navigate my own psychedelic experience.
But I think the major difference for a guide for me, which is probably why I’m a little averse to it anyways, is where does the power sit?
Like, the power should sit with you as a journeyer, it should sit with you as the individual. We’re actually talking about journeyer versus client versus patient here [laughs] in a second too. I’m talking in real-time, the conundrum that we’re describing.
Jimmy: When we talk about a guide, the power rests on them. They’re the ones with the knowledge and they’re the ones who hold all the cards and then they’re kind of telling you what to do in your experience and whatnot. Look, for some folks that’s right for them. I find that with psychedelic work there is no way that can unfold in real time.
Nick: There’s just no way that the provider can know what you’re going through-
Nick: -in real-time. You can guess, you can-
Nick: -you can intuitively. You’re right. But there’s no way they actually know 100% what it is that you’re experiencing because you probably couldn’t even vocalize what you’re experiencing.
Therapeutic Roles in The Facilitator-Client Relationship
[00:20:13] Jimmy: Yeah, so that’s why we landed on facilitator. And I think that one of the main reasons we did so is to keep that power intact to the person engaging in the psychedelic work. By facilitating, that means that we are supporting, maybe creating a structure, maybe offering some information and guidance.
Depending on the consent and the needs of the journeyer or the individual, the facilitator should be able to create a program or an offering or a service that makes sense for your needs. And so, you can see immediately that this word facilitation is not as strict as a guide or trip sitter.
And also has this sense that we’re supporters, like facilitating and supporting to me are akin to each other. And so, that I think helps folks to realize that there’s quite a lot of ranges and skill sets and modalities and ways that people conduct these psychedelic services and facilitation gives this broadness, I think.
And then also this focus on your experience, you as the journeyer. What else would you add to defining a facilitator?
Nick: I think for me I would sum it up that the facilitator helps facilitate a connection between you and your own inner healer. Like in an–[crosstalk]
Jimmy: And you and the psychedelic.
Nick: Right, they’re facilitating the connection between you and your inner healer, your highest self, and you and the medicine. But beyond that, you’re therapizing yourself. I think that’s where people get this so twisted is like they think that because it’s psychedelic-assisted therapy, the therapist is therapizing.
But what I see most often is that it’s actually the client is therapizing themselves. And that’s where the beauty of this whole thing lies is in the self-discovery because once you’ve experienced it or seen it or whatever firsthand, no one can take that from you.
It’s the difference between telling myself there’s nothing to fear and not believing it and then actually having the direct experience of like, “Oh, there’s nothing to fear.”
Jimmy: Yeah. And it’s up to you and your own agency and how you interpret and define whatever comes up in your psychedelic experience. And so, that’s a little of what you’re talking about as well, Nick, about where does it come from?
Where does the help and the healing come from? In our cases we’ve seen many, many times, it comes from the individual embarking on the experience.
Nick: Before we move on to the next, I guess, segment of words, I think it’s important to just acknowledge that the point of this whole discussion is that at this point nobody should be relying on a single word or definition to select their service.
There are additional questions and ways to dig into what’s included, what does it mean, what’s your approach? That to me is actually way more important than the label that’s attached to it because I think the gist of this discussion is that the labels don’t mean anything right now because we don’t have agreed-upon definitions.
Jimmy: Agreed upon definitions, agreed upon standards. Somebody says they’re certified and trained, that means something different to somebody else.
Nick: I mean, in Oregon right now, we talked about this, if you want to know in detail you can check out the episode of Measure 109 that we recorded a couple of weeks back.
You’re going to be a licensed facilitator in Oregon with very little training or requirements. And so, licensure also doesn’t inherently mean qualified or legitimate or knowledgeable. It’s a very funny time to be in the space, right now.
Jimmy: I mean, we see that in industries that are standardized.
Jimmy: Being a marriage and family therapist takes 3000 clinical hours, and I for damn sure know that I have seen some MFCs that suck, you know.
Nick: Yeah, for sure.
Jimmy: And I’ve seen some that are amazing as well. And so, when we think about Oregon, when we’re talking about a couple of hundred as opposed to a couple of thousand and then they’re a facilitator in Oregon’s psychedelic-assisted psychotherapy program, you can see how it gets mixed up real quick.
Nick: Yeah, you’re talking about a high school diploma and 200 hours and now you’re doing therapy on people.
Jimmy: Yeah. The last thing I’ll say about facilitator, what I like is that it also takes the emphasis off of the dosing session or the ceremonial day. And so, when I think about facilitators, I also think about facilitating programs which as we mentioned before, should include preparation, should include integration, and maybe some other things as well.
So, you’ve heard us throw this around, journeyers, people who take trips, I guess, clients, patients. I think those are all interchangeable as well and those go hand in hand with the services of which you’re engaging in.
Being Your Own Advocate as a Psychedelic Journeyer
[00:26:00] Jimmy: When I think about clients, those are folks who maybe are going through more of like coaching routes or those types of aspects. I think journeyer is a little bit more of like a catch-all term that can include participating in ceremonial experiences.
You may refer it to yourself just as a journey or by just engaging in psychedelics alone. I lead patients to mental health and medical applications of psychedelics, of which, again, not a lot of that is available to mainstream society yet. What else would you add here?
Nick: I view a client as anyone who pays for professional services of any kind. And I view a patient as someone who is actually engaging in services with a clinician of some sort or some sort of like true medical care.
There’s other terms like a participant, which are often associated with retreats. You’re a retreat participant, you’re not a retreat client or a retreat patient, you’re a part–[crosstalk]
Jimmy: Clinical trials, I see that a lot in studies, as study participants.
Nick: But interestingly enough, I had the same conversation with our team yesterday of call takers. I’m like, “How are people referring to themselves? Do they refer to themselves as journeyer or client?”
And it sounds like most of the time it’s client because journeyer is still unclear and not totally accepted in the folks who are starting to look for this type of service.
Jimmy: Yeah. The one reason I like the word journeyer is the same reason I like the word facilitator is that it denotes a process, it denotes something that you go through over time. And I think one of the pitfalls of this psychedelic interest nowadays is that there’s not enough emphasis on all the stuff that goes around the support of a dosing session or a ceremony.
You’re going to run across a lot of these different terms and phrases depending on who the service provider is. And it’s just important for you to know that a lot of these are used interchangeably. But it obviously depends on the context of service.
Nick: I think it’s just important that we re-highlight the challenge that service providers face right now which is, “Do we label ourselves what we actually think we are? Or do we use the term that you think we are?” And they may not be the same.
Jimmy: I mean look at even the regulation in Colorado. They’re defining facilitator, they’re defining healing center, but what does healing center actually mean and what modalities and skills are used and what clinicians are there versus coaches versus private practitioners?
And so, I think that there is an attempt, a movement to kind of define and coalesce these things but it is wide open right now. When in doubt, ask. A part of our intention is to help you to know the things to ask, so that you can make an informed decision on what’s right for you.
Nick: Yeah. And that’s the main point of this whole thing for me is just highlighting “Hey, this dynamic exists and you can get to the bottom of it if you ask the right questions.”
But please, please, please, my PSA for this episode is don’t rely on the label to inform the care that you think you’re going to get because it may or may not line up and the only way to know is to verify.
Jimmy: Yeah, a perfect example of this is a world that I live in which is psychedelic harm reduction and that looks really different depending on the context. For sake of this conversation, there’s harm reduction that exists all over the world like seatbelts in a car, headlights, tail lights, things like that.
Safety protocols at work and on and on and on. And psychedelic harm reduction looks really different depending on the context. If I’m out at a music festival, psychedelic harm reduction is going to look different than whether I’m engaging with you, Nick, for a ceremonial program.
And that will look really different than a clinical medical model where maybe they have to monitor you with stuff and things attached to you for a certain time. And so, even phrases like that, “Does the harm reduction include testing?”“What other safety protocols are there?”
So, just even know that around these phrases. It’s important for you to ask questions on, “Okay, what does that include? What does that entail? What does that mean?”
Nick: What are the qualifications of the provider? What is their background? What is their training? What’s their approach? How are they going to engage with me? Those are actually far more indicative of what’s actually going to unfold than whether they call themselves a guide or a facilitator.
Jimmy: Yeah. Well said. Well, I hope that was a helpful conversation. I know that we fired off a lot of information at you, but we just felt a calling to talk about this, because one of our driving intentions is how do we empower people to make their own choices with psychedelics in their own sovereignty. So, thanks for listening to us here. And that wraps up our episodes.
So, thank you for joining us. You can download episodes of the Psychedelic Passage podcast anywhere you find podcasts or get your podcast. Apple Podcast, Amazon, Spotify, iHeartRadio. If you like the show, please give us a rating and a review, and we look forward to seeing you next week.
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