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📋 In this issue

• Unpacking the nuanced terms for key approaches being used in the psychedelic therapy space. Which approach do you use or are you most interested in?

PAT, PAP, HRIT, or PHRI?

It's no secret the mental health profession loves their acronyms. The psychedelic therapy space is full of them. As more therapists begin to consider consultation or training in this area, let's unpack what some of the acronyms representing key approaches really mean.

PAT, or Psychedelic-Assisted Therapy

This is the term most commonly used on social media, mainstream headlines, and even research. Also referred to by some as PAP, or Psychedelic-Assisted Psychotherapy. These terms (PAT and PAP) are synonymous. "Psychedelic-assisted psychotherapy consists of the administration of a psychedelic in the context of a psychotherapeutic environment and relationship, with the therapist providing psychological support and in some cases specific intervention designed to align with the psychedelic experience and promote change in the target diagnosis." (Gorman, I. et al, 2021).

If we are using terms properly, PAT exclusively includes the type of therapy performed when therapists are involved in the therapeutic sessions utilizing a psychedelic substance. This area of the psychedelic therapy space requires extensive training to be competent in holding a therapeutic space for clients while in an altered state of consciousness, as well as understanding the risks with various drugs and nuanced ethical and clinical considerations.

HRIT, or Harm Reduction and Integration Therapy

If you've been reading my letters or follow me on Linked In, you've probably seen me use this term a lot. This refers to the approach of supporting therapeutic conversations before and after a client independently pursues a psychedelic experience. Coming from the substance abuse field, "harm reduction" recognizes the importance of having conversations with clients pursuing psychedelic experiences to reduce risk while working on therapeutic goals. "Integration therapy" refers to the third stage of the 3-stage psychedelic-assisted therapy model, helping a client integrate a psychedelic experience into their life and their treatment goals.

With PAT incorporating all 3 stages of the psychedelic-assisted therapy model and specifically the experiential stage 2, HRIT and PHRI only incorporate stages 1 and 3. Below is a graphic highlighting this nuance that I use on my website:

Many licensed therapists may already have enough training and experience to easily adopt this approach in their clinical practice, but the pursuit of additional education or consultation is always recommended.

PHRI, or Psychedelic Harm Reduction and Integration

PHRI and HRIT are synonymous. Kind of like PAT and PAP - when we use these terms we are talking about the same thing. For more context, I'll share a great summary: "PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy [preparation and integration], 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. " (Gorman I. et al, 2021).

So really just like whether you call it PAT or PAP, calling it HRIT or PHRI comes down to personal preference. While I've been using the term HRIT for awhile now, I honestly kind of like PHRI better just because it acknowledges psychedelics in the term. If you start seeing me write more about PHRI, now you know I'll still be talking about HRIT.

Summary

So really there are only two types of therapies being used in the psychedelic therapy space PAT/PAP and HRIT/PHRI - and it comes down to whether the therapist is involved in the therapeutic psychedelic experience with the client. HRIT/PHRI is heavily informed by the PAT/PAP model and supports stages 1 and 3. With stage two dominantly requiring the use of controlled substances, many therapists are reasonably uncomfortable with the idea of risking their license to do PAT, but doing HRIT/PHRI carries much less risk for the therapist and helps reduce potential risk for their clients as well.

Personally, even though I've completed the 100-hour MAPS MDMA-Assisted Therapist training, as an EMDR specialist I don't feel the need to ever do PAT/PAP. I've built systems around a 1-2 hour therapy session, using EMDR to help clients achieve all kinds of treatment goals. So trying to incorporate 8-10 hour psychedelic experiences into my model just doesn't compute. Even when these therapies become fully legal, I'll probably stick with my HRIT/PHRI approach, using EMDR to compassionately support clients before and after they independently pursue a therapeutic psychedelic experience (we recently formed an international working group of EMDR therapists doing this work, so this probably won't be the last time you hear from me about EMDR and PHRI!).

With the speed in which things are changing, I believe within the next 5-10 years therapists using a HRIT/PHRI approach in their work with clients will be as common as therapists who are informed by CBT. How blessed are we to be on the leading edge of this incredible, compassionate change in our field!?

Want to dive deeper with me on these topics? Let's consult!​

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Until next time,

Chris

PS- Have questions or topics you'd like to see discussed? Reply to this email and let me know!

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