Is preparation the most important part of Medicine Assisted Therapy?
In our experience at CMAT, the preparation phase of medicine-assisted therapy (MAT) is often undervalued and not well understood by clients. Yet it is integral, and I would argue is one of the most important factors in ensuring desirable outcomes with this therapeutic approach. Indeed, when we look at various traditions that include techniques for accessing expanded states of consciousness we see a consistent emphasis on the importance of good preparation. This post seeks to explain why the preparation phase of MAT is important and what kinds of things the therapist is focused on during the preparation process.
Over time, I’ve frequently had clients ask what preparation sessions are all about. There is often confusion as to why we would schedule several sessions before getting to the medicine part of the process. I’ve often had clients express that they’ve already been in therapy in the past or even presently and question whether they may be able to reduce the number of preparation sessions as a result. To me, all this signals a lack of understanding of the preparation process and its integral role in supporting safe and productive experiences within MAT. Whether it’s held with implicit or explicit awareness, I perceive that there is also belief or expectation embedded within these questions that the medicine itself is what will be the catalyst for the change, fix, healing or solution that the client is seeking. After all, isn’t that the innovative and novel part of the MAT approach?
On the surface, this way of thinking makes sense. The predominant approach in western medicine is that a patient takes a drug and it reduces some symptom or symptoms they are feeling and consequently they feel better. It stands to reason then that psychedelic medicines can and should do the same. However, that’s not the way we understand it with MAT. In this approach, the medicine is a tool rather than an antidote or something that will reduce or eliminate symptoms on its own. It’s a tool which when applied well has the expansive capacity to manifest varied, distinct and sometimes forgotten aspects of one’s mind, to touch deep places of empathy and compassion within, to recover lost memories, to help to connect to new insights, new realizations and new ways seeing oneself, others and the world. Rather than being focused on feeling better, it’s often about getting better at feeling.
As with any tool, the skill with which the medicine is used will impact the results. Thus, it is critically important to choose a well-trained, experienced, and skilled therapist for this kind of process. Such an individual will know and likely emphasize that every phase of the MAT process from proper assessment to preparation to medicine sessions and integration are all important aspects of the process and inseparable from one another. Moreover, all are essential to getting the most out of the medicine experience, particularly for individuals seeking treatment for mental health issues and/or those with therapeutic goals. The phases of this process are intentionally curated to enable the medicine and therapeutic aspects to support one another synergistically.
This is done with relational and therapeutic support provided by a therapist who seeks to help facilitate shifts in a client’s perspective, experience of their symptoms, their behaviour, and consequently their qualitative experience of life.
Okay, so maybe that sounds great and maybe it doesn’t, but I think the next question is probably, what are we really talking about here? What occurs during these preparation sessions? In the interests of brevity and digestibility, I’ve broken this down into a list of what we’re looking to accomplish during this phase of the process:
Provide education and information about the treatment approach, treatment plan, and other necessary administrative details.
Establish relational rapport and build trust between client and therapist.
Understand the client experience of presenting mental health issues and/or emotional difficulties.
Clarify the client’s treatment goals and any expectations they may have towards the treatment process, what the medicine experience may be like, and what impact it may have.
Getting to know the client’s history, traumatic experiences, personality, attachment style, cognitive and behavioural patterns, and coping mechanisms.
Develop understanding of the internal and external resources the client has available to them and what self-care currently looks like in their life. Beyond this, providing support to establish and strengthen resources and self-care practices.
Utilizing a holistic framework (such a biopsychosocialspritual model, ecological systems theory, medicine wheel, etc) to map areas of strength and opportunities for growth and development within a client’s life. Helping to find ways to support growth and development in the areas of the client’s life that may benefit from such.
Examining implicit and explicit fears, concerns, and apprehensions the client may have about this process and/or the medicine experience. If not explicitly addressed these can create blockages which limit the medicine experience and the process more generally.
Provide psychoeducation about therapeutic modalities that may be used and begin therapeutic work using these modalities.
Support the client to build and develop skills that may be supportive in the medicine session, throughout the process, and in their life more generally (e.g., present moment awareness, somatic awareness, tools to support nervous system regulation, ability to ask for help, and more).
Provide psychoeducation about expanded states of consciousness, the range and types of potential effects frequently elicited by the medicine they will be taking, and guidance on how to skillfully navigate these types of experiences.
Assist the client to establish a supportive mindset and clear intention(s) for the medicine experience.
Working collaboratively with the client to establish an optimal setting for the medicine experience. This includes the actual setting in which the medicine session will occur, as well as external aspects of the setting within the client’s life (e.g., home, work, relationships, schedule, etc).
Provide description of the course of events on the medicine day and explicit conversation and agreements around boundaries and client preferences regarding adjustable aspects such as music, eyeshades, and supportive touch.
Begin to establish practices and routines that will support the integration process. It is valuable to note that good integration begins during the preparation phase.
Provision of recommendations and referrals to outside resources and/or adjunctive services that may support the client’s treatment goals and healing process.
This list seeks to provide the reader with an initial understanding of what one may expect during the preparation phase of MAT. Hopefully it also communicates that there is indeed a lot of ground to be covered in these sessions. Even for individuals with extensive backgrounds in therapy, participation in MAT often involves a new therapeutic relationship and the therapist needs time to learn about their new client, their background, their goals, and their needs so that they can best support them throughout this treatment process. Although it’s understandable that clients are often keen to get to the medicine experience, time in preparation is time well spent and an investment that improves the likelihood of a beneficial outcome from MAT. As an example, in studies done by the psychedelic research program at Johns Hopkins University, therapists spend at least eight hours in preparatory meetings with study participants, and researchers emphasized this as being important for participant safety1. Thus, truncating or skipping over the preparation phase can not only lead to missed opportunities and disappointment, but can also increase the risks of harm that can arise from the psychedelic experiences.
The MAT protocols and treatment plans used at the Centre for Medicine Assisted Therapy are informed by research and evidence with care and attention given to all phases of the treatment process from assessment and preparation to medicine sessions and integration. Our team of therapists and health care providers are well trained with personal and professional experience in these approaches, and all emphasize the importance of proper preparation and integration to help improve the likelihood of beneficial therapeutic outcomes. Further, our therapists have all trained in complementary therapeutic modalities that have been shown to support MAT.
If you are interested in exploring whether MAT is right for you or if you want support preparing for a psychedelic experience, please reach out to us.
Please note that individuals with limited previous experience in psychotherapy will likely benefit from extending the preparation phase of their treatment process. If this applies to you, please ask us about this at your intake!
Written by: Cody Callon, MSW, RSW, CMAT Therapist
Reference:
1. Johnson M, Richards W, Griffiths R. Human hallucinogen research: guidelines for safety. J Psychopharmacol. 2008 Aug;22(6):603-20. doi: 10.1177/0269881108093587.
