Several years ago during a treatment for her lifelong depression with the psychedelic-like medication ketamine, Renee St.Clair was horrified to watch her brain disconnect from her body and float across the room.

“It was incredibly scary. I was really afraid it wasn’t going to come back,” the 51-year-old San Diego attorney recalls. The nurse attending her session quickly called in the psychiatrist, who verbally reassured St.Clair and squeezed her hand to make her feel safe. His soothing presence kept her calm during the 40 minutes until the hallucination passed and the drug was out of her system.

The importance of having well-trained professionals administer powerful psychedelic drugs is becoming urgent now. Not only will Oregon soon allow mental-health treatments with psilocybin—the active ingredient in magic mushrooms—but the United States Food and Drug Administration is expected to evaluate its first true psychedelic, methylenedioxy-methamphetamine (MDMA, aka ecstasy), for treating post-traumatic stress disorder later this year.

It was the realization that psychedelics might one day be integrated into mainstream medical care that spurred the California Institute of Integral Studies in San Francisco to become the first in the U.S. to offer a psychedelic-assisted therapy training program seven years ago, says Janis Phelps, director of the school’s Center for Psychedelic Therapies and Research.

In recent years, a growing number of institutions have followed. Psychotherapists, nurses, doctors, clergy, and others primarily in the mental health or spiritual professions are learning the chemistry of psychedelic molecules, safety concerns, historical Indigenous use, and, most importantly, the unique mental states unleashed by these drugs, whose effects last for six hours or more. But because psychedelics are currently illegal, no program enables participants to personally experience their effects.

Demand for these courses is booming, experts say, in large part due to a better understanding of the drugs’ potential mental health benefits. But national standards do not exist, leading to fears some graduates may have inadequate abilities as each institution create its own curriculum.

Inspired by promising clinical trials

Why are medical providers looking to MDMA as a potentially useful PTSD treatment? The powerful drug is thought to enable the brain to confront traumatic memories without triggering emotions like shame and rage, which can overwhelm and impede healing.

Preliminary results from the Multidisciplinary Association for Psychedelic Studies’ (MAPS) most recent large clinical trial confirm that two or three doses of MDMA reduced or eliminated PTSD. Most notable was that the effects persisted for six to 12 months. (These findings were released in April on MAPS’ website but have not been published in a medical journal.)

Positive results were also noted in MAPS’ first phase three clinical trial published in Nature Medicine in 2021, which showed that after three sessions of between 80 and 180 milligram doses of MDMA, three preparatory therapy sessions, and nine sessions post-medication, two-thirds of study participants no longer had PTSD.

Institutions around the world are revealing psychedelics’ promise for a range of mental-health disorders, including depression, anxiety, addiction, and reducing the fear of being diagnosed with a terminal disease.

Results like these inspired Anthony Back, a doctor at the University of Washington School of Medicine, to take the California Institute training in 2020. The 60-year-old Back says growing up in the 1980s around prominent antidrug ads kept him from experimenting in his youth. But the scientific research convinced him “there’s something really important here.”

In Back’s work as a palliative care physician, his primary goal is to reduce pain for patients with cancer. But “we haven’t had good ways of dealing with the terror” of learning your life is likely ending, he says.

How to administer a psychedelic drug

Institutions offering training programs vary greatly. Oregon has authorized nearly two dozen groups to conduct training for its statewide program, ranging from small facilities like the Earth Medicine Center to established universities including the University of California, Berkeley. Around the country, programs generally last six months to a year and cost thousands of dollars.

Most programs emphasize the importance of conducting multiple sessions before a drug is administered to discuss what patients hope to gain from the experience and what they might expect. Students also learn how to oversee the one or more sessions where the drug is administered. “The psychedelic experience is largely an internal one,” Phelps says, so therapists are taught not to interject themselves unless required to restore a sense of safety.

Administering psychedelic-assisted therapy is vastly different for professionals used to conventional mental-health treatments, says Bit Yaden, a psychiatrist at Johns Hopkins Medicine, who is working on a pilot curriculum for Hopkins, Yale, and New York University psychiatry students. “When I prescribe Lexapro, my patient picks up the prescription and I hear in a month how it’s going,” she says. But with psychedelics, the actual dispensing of the medicine along with subsequent talk therapy are required, she says. During the many hours of a psychedelic session, one or more therapists must remain in the room.

Trainees are also taught how to help with a process known as integration, where patients incorporate insights and emotions from their psychedelic trip into their everyday lives. Here too, conventional therapists can find themselves in novel territory. “In psilocybin trials, there are reports of people having mystical experiences. Talking about those experiences may not have traditionally fit in a psychotherapeutic framework,” Yaden says.

Some programs have adopted the belief that therapists are best positioned to help others process powerful insights only after they have dealt with their own mental-health issues. That’s why Vancouver Island University in Canada offers a year-long training with numerous personal-development exercises and discussions to foster the personal and emotional growth of the therapist. “Using psychedelics is a way of remembering who you are,” says Geraldine Manson, a member of Canada’s Snuneymuxw First Nation who teaches in the program.

Training without psychedelics

Because psychedelics remain illegal, most programs are unable to have students facilitate an actual session with a psychedelic, an unfortunate limitation to their training, Phelps says. (Vancouver Island’s students, however, can do so because of government waivers allowing some mental-health patients to legally use the drugs.)

For the same reason, many students haven’t had personal experience with the drugs either. “It is clear when someone has never used a psychedelic. The types of questions they ask shows they have no idea what experience they’ll be providing to their patient,” says Pam Kryskow, medical chair of the Vancouver Island program.

Some encourage students to try ketamine under supervision to understand the extreme vulnerability of a being under the influence. Others attempt to simulate the state with a breathing practice known as Holotropic breathwork, which employs fast respiration to yield temporarily altered consciousness.

Some trainees seek out their own psychedelic experience with an underground guide or through by traveling to countries where Indigenous populations have long used the drugs. Palliative-care physician Back used a guide several years ago, an experience that prompted his desire to take the training. During the experience, as he later wrote in a medical journal, “my familiar sense of ‘me’—my preferences, my body, my history—dropped away, all at once, and what became palpable was an oceanic sensation of being unified with everything….There was a sense of being complete belonging…of having access to an energy in the universe that normally was hidden. It was exhilarating.”

Back believes such a framework would be helpful for his terminal patients. “I realized the process of dying was much more spiritual than I knew,” he now says, and he is eager for these drugs to be legalized.

Other medical professionals apparently feel similarly. In the California Institute’s first class of 42 students, several doctors and nurses insisted their participation be kept quiet to avoid potential harm to their professional reputations. But this year, some 800 people competed for the school’s 400 slots.

Despite the growth, experts worry there won’t be enough trained therapists to meet the expected demand after FDA approval of MDMA and possibly psilocybin, when thousands of professionals will be needed. In Oregon, not a single facilitator has so far met all criteria to be granted a license for psilocybin therapy.

“No training program is keeping up with the demand,” Phelps laments. Her university is developing a licensing program so other colleges can obtain the school’s training materials and videos, with some 25 already expressing interest, she says.

The only way psychedelics can succeed as a mental-health remedy is by ensuring enough professionals receive high-quality training, Back says. “This is a different kind of treatment than most others. Those are about the technology or the drug. Here, you have to have the therapy and the medicine together.”