Psychedelics for Therapy 101: What Canadians Need to Know

Psychedelic therapy (also called psychedelic assisted therapy (PAT), or psychedelic integration) combines psychedelic experience, typically overseen by a qualified guide, with traditional talk therapy. 

In clinical trials, psychedelics in therapy have shown promising results treating symptoms like PTSD and depression. But not all psychedelic therapy targets specific issues. Many patients try psychedelic therapy in pursuit of overall spiritual or psychological growth.

Here’s what you need to know about psychedelic therapy in Canada. Approach this guide as a jumping-off point into deeper research. And, as always, consult with a qualified therapist before beginning any new course of treatment.

Is psychedelic therapy legal in Canada?

In very specific cases, psychedelic therapy is legal in Canada. There are steps therapists and patients can take to access otherwise illegal substances and use them for therapeutic purposes.

In every other case, psychedelic assisted therapy lies in a legal grey zone. Either a therapist or a patient could theoretically be charged with buying or possessing a controlled substance. But there are no laws against psychedelic therapy per se. 

Who can provide legal psychedelic therapy in Canada?

Only a licensed therapist, Only a medical practitioner entitled under the laws of their province to treat patients with prescriptions is able to provide legal psychedelic therapy in Canada.

They can do so in one of two ways:

1. By requesting psychedelic substances through the Health Canada Special Access Program (SAP)

Licensed therapists, with the assistance of a medical practitioner able to prescribe medication, can access controlled substances by putting in a special request through the SAP.

To date, therapists may only use the SAP when treating patients with:

• Treatment-resistant depression 
• Treatment-resistant PTSD
• End-of-life anxiety when terminally ill

Also, any patient preparing to undergo Medical Assistance in Dying (MAID) qualifies for access to these drugs.

Typically, only psilocybin and MDMA are available via the SAP.

2. By administering ketamine with a doctor’s prescription

Unlike substances acquired via the SAP, ketamine may be prescribed off-label to treat a range of conditions.

A number of clinics across Canada offer clinical ketamine treatment. Requirements for approval vary from one clinic to the next, and treatment typically costs at least several thousand dollars. The cost of ketamine treatment is not usually covered by extended health benefits.

Who offers underground psychedelic therapy in Canada?

Numerous professionals in Canada—both licensed practitioners and other, non-licensed individuals operating under such titles as “healers,” “guides,” “shamans,” etc.—provide patients with underground psychedelic assisted therapy.

In the context of psychedelics in therapy, “underground” means operating outside the law. While there are no laws against preparing patients for psychedelic experiences or helping them to integrate their experiences after the fact, facilitating the use of controlled substances is illegal.

In order to avoid legal liability, some professionals may stipulate that patients obtain and provide their own controlled substances. In that case, the therapist specifies dosage and type of substance.

Others may provide pre- and post-experience counselling (“preparation” and “integration”, covered below) and harm reduction education, with the patient undergoing the experience themselves with a different individual. 

Finally, some therapists, willing to undergo the legal risk and aiming to offer patients a safe supply, provide the psychedelic substances themselves.

There are numerous training programs for psychedelic therapy training in Canada that implicitly or explicitly acknowledge underground treatment. They prepare practitioners to facilitate psychedelic experiences. While licensed therapists may advertise their certifications under programs of psychedelic therapy training in Canada, no single program sets any kind of “industry standard.”

Harm reduction and psychedelic therapy in Canada

Some therapists take a harm reduction approach to providing psychedelic therapy.

Following this line of thought, there are many people seeking psychedelic therapy, even if they don’t qualify under the SAP. Some of these individuals will obtain controlled substances and take them in non-clinical settings even if they don’t have legal access to them. And they may do so without a therapist or guide to oversee the treatment.

That presents dangers common to anyone using mind-altering substances alone or without adequate support and guidance. 

At minimum, they’re in danger of undergoing a “bad trip,” a psychedelic experience that may do more harm than good to their mental state if not contextualized through integration therapy. In that case, the support of a qualified therapist or guide is important for preventing long-term psychological harm. 

None of this is hypothetical. Individuals, past and present, have used psychedelics on their own for self-directed therapy, with varying results. A 2020 global drug survey raised concerns over patients self-administering psychedelics.

What does psychedelic therapy in Canada treat?

Certain conditions have been proven to respond well to psychedelic therapy; for others, there is a lack of data—outside of anecdotal experiences—proving whether psychedelic treatment has either a positive or negative effect.

Clinical studies have shown the benefits of:

• Psychedelic therapy for depression
• Psychedelic therapy for anxiety
• Psychedelic therapy for PTSD
• Psychedelic therapy for veterans
• Psychedelic therapy for OCD
• Psychedelic therapy for addiction
• Psychedelic therapy of alcoholism

Not all patients who pursue psychedelic assisted therapy do so in order to treat a specific condition. Every year, more people turn to psychedelics to help them gain new perspectives on their lives and grow emotionally and spiritually. 

Also, for patients who are already undergoing long-term non-psychedelic therapy, a course of psychedelics may help them break out of a plateau in progress or overcome obstacles in their treatment.

What does psychedelic therapy actually do?

It can be difficult to describe a powerful psychedelic experience. And the outcomes of psychedelic therapy aren’t always easily captured in scientific studies.

To get a better sense of what psychedelic therapy is really like, it helps to turn to anecdotal evidence. 

Here are a few stories of psychedelic treatment shared by guests on First Session’s Actualize Podcast:

• Despite his successful career in Silicon Valley, Andy Johns was suffering. The effects of childhood trauma made day-to-day life painful to navigate, and it was time for a change. He discusses how an ayahuasca ceremony helped him address his trauma and change tracks.

• Alessia Scauzillo struggled with grief after losing multiple family members—including her mother—in a short span of time. Conventional therapy coupled with psilocybin mushroom retreats opened new doors to processing her grief and finding peace.

• USMC Veteran Christopher Brown suffered PTSD after being wounded in Afghanistan. Now a licensed therapist, he helps US veterans heal through MDMA therapy.

For testimonials from patients who have undergone psychedelic therapy, visit the Nikean Foundantion.

Is psychedelic therapy right for me?

Before deciding (with the help of a licensed therapist) whether psychedelics are right for you, it helps to understand how psychedelic treatment is structured. 

Set and setting

Researchers in psychedelics and adjacent fields have used the term “set and setting” since at least 1961, when it was popularized by Timothy Leary.

In psychedelic therapy, set and setting are carefully controlled in order to create ideal outcomes for the patient.

Set consists of “mindset,” or the emotions and attitudes of the patient. Both affect their experience. An anxious or fearful patient may find their anxieties and fears magnified under the influence of psychedelics.

Similarly, a patient with misapprehensions about the treatment will bring them to bear on their experience. If they distrust their therapist or guide, or if they believe the psychedelic they’re using could harm them, it could lead to a negative experience.

Setting consists of physical surroundings. Under the influence of psychedelics, a patient’s judgement and perceptions are altered. Their surroundings must prioritize physical safety, comfort, and privacy.

The setting may also have mental or emotional impacts on the patient. Loud, busy surroundings won’t facilitate the type of focused, introspective experience most patients (and therapists) seek in psychedelic assisted therapy. 

The structure of psychedelic therapy

While there are variations, a full course of psychedelic therapy is typically divided into four parts:

1. Education
2. Preparation
3. Facilitation or journey
4. Integration

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1. Education

Education is essential before a patient embarks on a course of psychedelic therapy. During this stage, a therapist may work with a client to help them understand:

• The purpose of the therapy
• What types of experiences they may undergo
• The possible long- and short-term effects

This is also the stage where the patient decides if psychedelic therapy is right for them, or whether they’d prefer to pursue a more traditional form of therapy.

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2. Preparation

Sessions during the preparation phase may take the form of a dialogue about what the patient hopes to “get out” of their treatment, like:

• Particular issues they want to address
• Memories they wish to explore
• Perspectives they want to shift 

This stage is also important for setting realistic expectations and giving a patient the tools to approach the experience productively.

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3. Facilitation or journey

Facilitation or the journey consists of the psychedelic experience itself. This may occur just once, or multiple times over multiple sessions. The journey takes place in a safe, quiet environment, where the patient is monitored at all times by one or more guides. 

Usually there is a couch or bed for the patient to lie on, with pillows and blankets; water and bathroom facilities; and items like eye covers and ear protection in case they find sights or sounds overwhelming, or wish to experience more intensely their “inner” experiences.

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4. Integration

After the journey, one or more integration sessions help the patient to process their psychedelic experience. A powerful psychedelic experience may have life-changing positive effects, but only if it is contextualized and explained within the larger narrative of the patient’s life and their perceptions of self. It’s because of the importance of this integration phase that psychedelic assisted therapy is sometimes referred to as “integration therapy.”

Integration-only therapy

Some patients choose to facilitate their own psychedelic experiences for spiritual or therapeutic reasons. Others may take a psychedelic recreationally, but have an experience—positive or negative—so powerful that it challenges their normal perspective or way of living.

In such cases, therapists may offer integration-only therapy. This type of treatment is similar to the integration stage of a full course of psychedelic therapy, with some key differences:

• Recounting the experience. During a guided psychedelic session, a therapist may take notes on the patient’s experiences. They have “unedited” insights into the journey, and may be able to gather information the patient later forgets. With integration-only therapy, it’s up to the patient to provide details as they remember them.

• Addressing perspective shifts after the fact. The patient may already have undergone major changes in perspective due to a powerful psychedelic experience. And they may already have spent some time struggling to integrate them with their existing worldview and attitudes without outside help. Now, their therapist must help them clarify these changes and fully integrate them with day-to-day life.

• Anxiety and uncertainty. A powerful psychedelic experience—particularly a “bad trip”—may leave someone feeling anxious or uncertain about their own mental health. It’s up to the therapist to help them address trauma and repurpose the experience to have a positive effect.   

In almost every case, a guided, monitored psychedelic experience is likely to have better therapeutic outcomes than one undertaken by the patient alone. 

If you or someone you know is struggling with the aftereffects of a powerful psychedelic experience, contact a qualified therapist specializing in integration ASAP. Psychedelic therapists are trained to provide non-judgemental guidance and healing at every stage of the journey.

What are the dangers of psychedelic therapy in Canada?

Before pursuing psychedelic therapy in Canada, make sure you understand the risks involved.

Legal risks

Possessing or transporting controlled substances is illegal. Your personal legal risk depends upon the type of substance in your possession, the amount, and your location. 

Some provinces and jurisdictions have partially decriminalized drug possession for personal use. 

Long-term physical health

Administered under supervision in controlled dosages in clinical settings, none of the substances used for psychedelic therapy have long-term impacts on physical health. 

Certain substances—particularly MDMA—may cause increased heart rate and body temperature, but these effects are temporary and not dangerous to healthy adults.

If you have an ongoing health condition or if you take medication (including SSRIs), consult a physician before taking any psychedelic substances.

Contaminated supply

The biggest physical threat in psychedelic therapy comes from contaminated supplies of controlled substances obtained from black market sources.

With no official oversight of manufacturing and packaging, contamination is a serious danger. A small amount of fentanyl or carfentanil contamination can have deadly effects. 

Also, black market suppliers may intentionally dilute substances in powder or pill form with additives. Less commonly, liquid or blotter LSD may contain research chemicals—newly-synthesized and little-documented psychedelic compounds—mimicking the effects of pure LSD.

Testing kits available online or from safe drug supply foundations may be able to detect the presence of harmful additives or contaminants in psychedelic substances. 

Psychosis and mania

In very rare cases, use of psychedelic substances may trigger psychotic or manic states. This can occur even in clinical settings with controlled dosages. Patients with a family history of psychosis and mania are at a higher risk than the general population.

Researchers have not been able to identify the mechanisms behind these triggers. Consult with your therapist about any family history of psychosis or mania before beginning psychedelic therapy.

Hallucinogen-persisting perception disorder (HPPD)

Rarely, users of psychedelic substances experience hallucinogen-persisting perception disorder (HPPD). The visual effects caused by the substance continue after the experience has ended, and may last for days, months, or even years. In some cases, the effects may subside, only to return during periods of stress.

Patient experiences are highly variable, and while HPPD is a recognized DSM-5 diagnosis, the mechanisms behind it are not well understood. 

HPPD is not limited to the use of psychedelics. Some individuals experience the onset of HPPD without ever taking any substances. Others experience HPPD after using cannabis or taking SSRIs.

Long-term mental health

As with long-term physical health, substances administered in controlled dosages in clinical settings do not pose a danger to long-term mental health.

Some substances used in psychedelic therapy may be psychologically addictive, but addiction is unlikely to develop from isolated, therapeutic use.

In the very rare event a patient enters a psychotic state during treatment, their psychosis may cause long-term damage or changes to their brain. And patients suffering HPPD may find the condition has long-term effects on their mental health.

Clinician abuse

It’s essential, when planning to try psychedelics in therapy, to find a therapist with the right experience and training for the job. Personal fit—how well you get along with a particular therapist—is also a key factor. Plus, any therapy your hire should subscribe to a strict code of ethics.

That’s because psychedelic therapy makes you vulnerable in ways traditional therapy does not.

While you’re under the effect of psychedelic substances, your judgements, perceptions, and inhibitions are altered. Unethical therapists may use the situation to take advantage of you.

That could include sexual abuse or exploitation; financial exploitation; or intentional, controlling manipulation of your beliefs and behaviours.

It’s also possible for someone providing psychedelics in therapy to cause harm unintentionally. For instance, a therapist who integrates touch therapy with psychedelic facilitation may cross boundaries without being aware of the fact. Or a therapist with strong spiritual beliefs tied to the use of psychedelics may use them to frame or even control your experience and viewpoint.

All therapeutic relationships are complex and should conform strictly to ethical guidelines in order to keep patients from harm. 

Take the time to carefully research your options and thoroughly vet individual therapists before embarking on a course of psychedelic therapy.

How to find the right psychedelic therapist in Canada

Therapists offering psychedelic treatment in Canada may provide full or partial treatment. That is, some therapists exclusively provide preparation or integration therapy for psychedelic experiences, without facilitating the experiences themselves.

Because of legal barriers, therapists offering underground facilitation (guiding patients through psychedelic experiences with substances obtained outside the SAP) may advertise their services broadly, without going into specifics about what stages of psychedelic treatment they cover. 

In that case, the best way to learn more about treatment is to book a consultation call.

Where to find psychedelic therapists

If you know others who have undergone psychedelic therapy, they may be able to refer you to qualified therapists. 

Otherwise, try:

• Online directories. Some, like First Session, allow you to specify psychedelic therapy or integration therapy as a modality when searching for a therapist.

• Training program directories. Some psychedelic therapy training and certification programs offer public directories of their members. Others, if you contact them directly, may be able to connect you with certified therapists.

• Local online groups. Searching Facebook for “psychedelic therapy in [your area]” (or similar terms) may connect you with patients who can recommend practitioners.

• Referral from your current therapist. If you are currently seeing (or have formerly seen) a therapist who does not offer psychedelic therapy, they may be able to refer you to a therapist who does.

What to look for in a psychedelic therapist

When deciding whether a particular psychedelic therapist is right for you, consider the following:

Training

What sort of psychedelic therapy training in Canada has the therapist undergone? How long was the training program, and what did it cover? Programs may differ radically from one another, and new ones are continually being launched. Do your own research into any programs your potential therapist has completed. 

If necessary, contact the program directly to confirm the therapist completed it and remains in good standing.

Experience and reputation

Can your potential therapist provide professional or character references (preferably from other therapists)? Do they have any client testimonials they can share?

Besides references and testimonials, a qualified psychedelic therapist should be clear and upfront about their experience level—that is, how long they have been facilitating psychedelic treatment, or providing patients with preparation and integration therapy.

Safe supply

If your condition makes you eligible for SAP, confirm that any potential therapist is able to request substances through the program.

On the other hand, if the therapist is facilitating underground psychedelic experiences, find out what role they play in obtaining necessary substances. Do they provide substances themselves, or can they connect you with a trustworthy source? If it’s up to the patient to provide the substance, does the therapist offer testing?

Make sure any therapist you work with is trained in administering naloxone (in case of contaminated substances) and in first aid.

Methodology

There are a variety of approaches to psychedelics in therapy. The one your therapist takes may depend on their training or on their personal experiences.

For instance, some individuals offering psychedelic therapy, particularly those operating outside the traditional roles of therapist (healers, guides, etc.) may use a particular spiritual or religious tradition (or traditions) to frame treatment. 

Prior to undergoing facilitation (the “journey” stage of psychedelic treatment), make clear your expectations and boundaries and find out what methods the therapist uses to protect patients. For instance, many therapists make sure there are two guides present during psychedelic experiences for the sake of accountability.

Personal fit

As a good rule of thumb, don’t pursue psychedelics in therapy with a particular therapist if you wouldn’t hire them as a therapist otherwise.

That is, if you wouldn’t see a particular therapist on an ongoing basis using traditional modalities (eg. talk therapy, cognitive behavioural therapy), then there is no reason you should see them for psychedelic therapy.

As with all forms of clinical therapy, the therapeutic relationship is key. You should feel comfortable around your potential therapist, and confident in their ability to treat you. That still applies even if you’re seeking psychedelic therapy.

Your therapist’s specializations, personal identity, and style of treatment should all come first when deciding on psychedelic therapy.

Summary

• Patients seeking psychedelic therapy enabled by the SAP must be diagnosed with treatment-resistant depression or PTSD, or be undergoing end-of-life care

• Ketamine therapy, using medical ketamine for off-label purposes, is available for a wide range of symptoms with a doctor’s prescription

• Underground psychedelic therapy, acting outside the law, comes with its own set of risks; aside from legal risks, the biggest physical danger is tainted drug supplies

• Psychedelic therapy may have positive, life-changing effects, but only when the experience is contextualized through the preparation and integration stages of treatment

• Many therapists offer integration therapy for patients who have already undergone psychedelic experiences and need help contextualizing them within their own mental health journeys

• There are a wide range of training programs and certifications for psychedelic therapy. No single program is an authority.

• As a rule of thumb, don’t hire a therapist for psychedelic therapy if you wouldn’t be enthusiastic about seeing them for traditional therapy.