Australian Multidisciplinary Association for Psychedelic Practitioners
AMAPP has been formed to be the peak body for legal psychedelic-assisted therapy (PAT) in Australia; providing a framework for its safe, ethical, accountable and effective introduction focusing on the best client outcomes. We are a registered charity with the ACNC and the ATO and our mission involves education and advocacy.
If you are a healthcare practitioner with an interest or training in Psychedelic assisted therapy (PAT) click the button below:
Our Vision
A world where all those in need have access to high-quality evidence-based psychedelic-assisted therapy through an easily accessible network of trained, qualified and credentialed practitioners. Read more...
Our Mission
Our aim is to provide governance and educational resources for healthcare practitioners, the general public and stakeholders to help achieve our vision. Read more...
Our Education
See our education content for patients and public or become a member for ongoing clinical education resources. Read more...
Our Governance
Clinical governance is the set of relationships and responsibilities to ensure good clinical outcomes. Read more...
FAQ
Psychedelic-Assisted Therapy refers to a specific, controlled method of psychological therapy that involves the ingestion of a psychedelic drug such as psilocybin which is a compound found in certain mushrooms. In the modern context, it also includes MDMA which is not a classic psychedelic, but the treatment paradigms are similar with some important differences. The therapy most often involves two trained psychedelic therapists and the entire process can take many weeks to complete. See below
The word ‘psychedelic’ means ‘mind manifesting’ and under the right circumstances, these medicines can allow subconscious ways of thinking to come into conscious awareness and allow for changes to occur. They can create a situation where entrenched rigid thinking and behavioural patterns that are limiting or unhelpful can be changed and become more adaptable.
This neuroplasticity (changeable mental state), when nurtured correctly can effect changes that are long-lasting or permanent.
However, like with any medicine, when used incorrectly they have the potential to cause harm. In the case of psychedelics if vulnerable people are ill-prepared to navigate what may manifest for them, or do not have the correct support to make sense of the experience, psychological trauma can result. These “bad trips” can cause sustained detrimental impacts; however, this is rare with properly trained therapists in controlled settings with appropriate attention to preparation and setting. While many experiences can be very challenging, emotional and confusing, the trial data shows clearly that these can be the most beneficial and healing when the client is well prepared and well supported.
What does it look like?
The treatment begins with an assessment and careful history-taking by the treating therapists. Across multiple preparation sessions over days or weeks your therapy team will assess and fully prepare you for the dosing session. The dosing session lasts for up to 6h with psilocybin and 8-10 hours with MDMA. Following this session, over the subsequent weeks and months, you will undergo the 3rd phase of the treatment which is integration. This involves carefully exploring and making sense of the experiences and insights that may have occurred whilst under the influence of the medicine. This is a crucial stage as it attempts to solidify the changes that may have occurred in your thinking to allow for permanent changes to take place. Without attention to integration, old habits and thinking patterns may return.
Who benefits from this kind of therapy?
While thousands of trials over many decades have shown benefits for a variety of conditions, the modern research over the last 15 years has shown benefits for Treatment-Resistant Depression (TRD), anxiety, addictions, Post Traumatic Stress Disorder (PTSD) and more, with more robust trial protocols than some of earlier clinical trials. We also have a much better understanding of the brain regions affected which helps explain how these changes occur. This data led the Therapeutic Goods Administration (TGA) to announce in February 2023 that Psilocybin would be able to be prescribed in Australia (under very strict conditions) by accredited psychiatrists for the treatment of TRD only and MDMA for the treatment of PTSD only. This change came into effect on 1 July 2023.
How do I get treatment?
If you have been diagnosed with one of the above two conditions, speak to your therapist and if they are unsure of the process, they can contact AMAPP for advice. You will need to be referred to an Authorised Prescriber psychiatrist (AMAPP will have a list) after being assessed by your GP to provide a full medical history. The psychiatrist will have the final say after consulting with your usual therapist.
How safe is it?
The medicines themselves are amongst the least harmful of all mind-altering drugs. They do not cause addiction and are not prone to abuse. They have limited effects on the body and are safe for most people. There are certain conditions and medications that are contraindicated with certain psychedelics, which is why a medical assessment must take place to assess suitability. Also, their ability to affect the mind so profoundly can cause psychological harm in uncontrolled circumstances as mentioned above.
Read more... about AMAPP's clinical governance policy.
As of 2024, psychedelics in Australia are legal to prescribe in a very specific and controlled context. The Australian Therapeutic Goods Administration (TGA) reclassified MDMA and psilocybin in February 2023, allowing their use for medical purposes. Specifically, these substances can be prescribed for the treatment of post-traumatic stress disorder (PTSD) and treatment-resistant depression. However, it's important to note that their use is highly regulated and restricted to a medical setting under the supervision of licensed medical practitioners.
Psychedelic therapy, when conducted responsibly and within legal and ethical boundaries, generally demonstrates safety and positive outcomes. However, it's crucial to acknowledge that adverse effects and severe outcomes can occur, particularly when psychedelics are used inappropriately, without professional guidance, in high doses or combinations. Below are some of the adverse effects in psychedelic therapy:
Psychotic Episodes:
High doses of psychedelics can induce acute psychotic episodes, characterized by severe confusion, disorganized thoughts, paranoia, hallucinations, and a loss of contact with reality. This can be terrifying and distressing for the individual and may require immediate medical intervention.
HPPD (Hallucinogen Persisting Perception Disorder):
HPPD is a rare, distressing condition where individuals experience persistent visual disturbances, such as trails or halos around objects, even after the effects of psychedelics have worn off. This can significantly impair daily functioning and quality of life.
Suicidal Ideation or Behaviour:
In rare cases, psychedelics can trigger intense emotional experiences or existential crises, leading to severe depression, anxiety, or suicidal thoughts or behaviour. This underscores the importance of careful screening and monitoring during psychedelic therapy.
Flashbacks and PTSD:
Some individuals may experience distressing and intrusive flashbacks of their psychedelic experiences, akin to symptoms of post-traumatic stress disorder (PTSD). These flashbacks can severely disrupt daily life and mental well-being.
Re-traumatization:
Individuals with a history of trauma may experience re-traumatization if the psychedelic experience unexpectedly triggers traumatic memories or emotions. This can exacerbate their existing trauma-related symptoms.
Psychological Dependence or Abuse:
While these drugs are not prone to abuse or addiction, chronic or excessive use of psychedelics can lead to psychological dependence, where individuals may feel unable to cope with their emotions or daily life without using these substances. This can result in repeated regular use without integrating the experiences to make lasting change.
Disruption of Relationships and Social Isolation:
Profound personality changes or altered beliefs resulting from psychedelic therapy can strain relationships with family and friends, potentially leading to social isolation and feelings of disconnection.
Physical Injury or Harm:
The altered state of consciousness induced by psychedelics may impair judgment and coordination, increasing the risk of accidents, self-harm, or harm to others. The risks of physical damage from the drugs themselves is very low.
Depersonalization:
Definition: Depersonalization involves feeling detached from oneself or as if one's thoughts, feelings, and actions are not their own. It can lead to a sense of being an observer of one's own life rather than an active participant.
Potential Causes in Psychedelic Therapy: High doses or challenging experiences during psychedelic therapy may induce feelings of depersonalization. Individuals may report a disconnection from their body or a distortion of their sense of self.
Distress and Anxiety: Depersonalization can cause distress, anxiety, or a sense of unreality, especially when individuals struggle to reconnect with their usual sense of self.
Duration: While depersonalization during a psychedelic experience is not uncommon, it typically subsides as the effects of the substance wear off. However, persistent depersonalization can be a sign of underlying psychological concerns.
Derealization:
Definition: Derealization involves a perception that the external world is unreal or distorted. Individuals experiencing derealization may feel as if their surroundings are artificial, dreamlike, or somehow altered.
Potential Causes in Psychedelic Therapy: Similar to depersonalization, derealization can be triggered by intense or challenging psychedelic experiences, leading to a distorted perception of the external environment.
Cognitive Disconnection:
Cognitive disconnection is the experience of feeling distant and detached from one's sense of identity, thought stream, and general cognitive processes. Feeling as though one's conscious thought stream and memories are not one's own.
Feeling as if one's conscious thought processes are distant and vague.
Feeling as if one's conscious thought processes have become autonomous and mechanical in their structure or behaviour.
Feeling a decrease in the overall speed, connectivity, and analytical abilities of one's cognitive abilities.
Duration: Like depersonalization, derealization typically diminishes as the effects of the psychedelic substance wear off. However, persistent derealization may warrant attention and therapeutic support.
It's important to note that depersonalization and derealization are phenomena that can occur in various contexts, not just psychedelic therapy. Factors such as pre-existing mental health conditions, the individual's psychological state, and the setting in which the psychedelic experience takes place can influence the likelihood and severity of these effects. Careful screening, preparation, and therapeutic support can help mitigate the risk of distressing depersonalization and derealization experiences during and after psychedelic therapy sessions.
Legal Consequences:
Engaging in illegal or unregulated psychedelic therapy carries legal risks, including criminal charges, fines, or imprisonment, depending on local laws.
Ethical Violations and Exploitation:
Individuals seeking psychedelic therapy may encounter unscrupulous practitioners who exploit their vulnerability, charge excessive fees, or engage in unethical behaviour, causing emotional and financial harm. Due to the intense nature of the experience, time spent with therapists and the emotional vulnerability the drugs induce, patients may feel very close to their therapists. This is normal, helpful in building trust and is managed easily by an experienced therapist with open and honest discussions.
It is never appropriate for a psychedelic practitioner to engage in a sexual relationship with a client. The power imbalance means this is never an equal relationship and great harm can result.
It's important to emphasize that these worst outcomes are rare and typically occur when psychedelics are used irresponsibly, without appropriate guidance, or in unsuitable settings, doses and combinations. Responsible use of psychedelics in a therapeutic context, with proper preparation, supervision, and integration, significantly minimizes the likelihood of these severe outcomes. AMAPP has very strict clinical governance policies in place to protect patients and provide clear expectations of how to address adverse events.
Informed consent is the process whereby a decision is made with all the information required.
Consenting a patient to an ineffable (unable to describe in words) experience, such as a psychedelic therapy session, poses unique challenges due to the often ineffable (cannot be described in words) nature of these altered states of consciousness. Here are the main difficulties in obtaining informed consent for such experiences:
Inexpressible (ineffable) Nature of the Experience:
The profound and transformative nature of psychedelic experiences often defies verbal explanation. Describing the full scope of potential emotional, cognitive, and changes in perception during the session is challenging, making it hard for individuals to truly grasp what they might encounter.
Personalized Experience:
Individual psychedelic experiences vary greatly, influenced by a person's unique psychology, history, current setting, preparation, therapist presence, relationship with therapist and current mental state. Predicting the specifics of what a person will undergo is nearly impossible, adding uncertainty to the consent process.
Limited Frame of Reference:
Many individuals lack a prior frame of reference or cultural framework for understanding the depth and intensity of a psychedelic experience. People might have expectations based on anecdotes or media portrayals, but these often fall short of capturing the full spectrum of possibilities.
Varying Intensity and Duration:
Psychedelic experiences can vary widely in terms of intensity, duration, and the specific effects felt. Communicating these variations and the unpredictability of the experience is challenging, making it hard to provide precise details for informed consent.
Language and Cultural Barriers:
Ineffable experiences may be influenced by cultural, linguistic, or personal background, making it difficult to communicate the potential effects in a way that is universally understood and appreciated. Western culture has mostly lost it's connection to psychedelic medicines that flourished in Europe 1000-3000 years ago. We don't have a spiritual or cultural context for them anymore.
Potential for Overwhelming Emotions:
Psychedelic therapy can evoke intense and overwhelming emotions. This is hard to describe making it challenging for individuals to make informed decisions or fully comprehend the emotional impact beforehand.
Fear and Anxiety:
The fear of the unknown can create anxiety and uncertainty for the individual, which may further hinder their ability to provide informed consent for an ineffable experience. There may be fearful experiences during the session and these are often a manifestation of the individual's subconscious.
What if I change my mind?
This may occur for example with consent to touch. (see FAQ on touch)
You should be able to alter consent at any time and have your wishes respected. Your therapists have a duty of care meaning you will need to stay in the treatment room until it is safe for you to leave.
To address all these challenges, healthcare providers play a crucial role in providing comprehensive pre-session education and creating a safe, supportive environment for individuals to express their concerns and ask questions. Informed consent discussions should emphasize the range of potential experiences, acknowledge the ineffable nature, and reassure individuals that their well-being and boundaries will be respected throughout the journey. Open and honest communication remains key to helping individuals make the best-informed decision regarding their participation in psychedelic therapy. These discussions must be documented and signed by both parties.
Unethical therapist behaviour in psychedelic therapy is a serious concern that can have significant detrimental effects on individuals undergoing treatment. The vulnerable and transformative nature of psychedelic experiences amplifies the potential harm caused by unethical practices. Below are some of the key issues associated with unethical therapist behaviour.
Lack of Professional Training and Qualification:
Some therapists may lack proper training, qualifications, or certifications to conduct psychedelic therapy safely and effectively. Especially when dealing with serious mental health disorders. This can jeopardize the well-being of individuals and lead to harm.
Inadequate Informed Consent Process:
Informed consent is a complex issue when it comes to Psychedelic therapy. Unethical therapists may rush or manipulate the informed consent process, failing to adequately educate individuals about the risks, benefits, and nature of the psychedelic experience as well as alternatives. This can violate the individual's right to fully understand what they are consenting to.
Misleading Information and False Claims:
Some therapists might make exaggerated or false claims about the therapeutic potential of psychedelics, promising outcomes that are not scientifically supported. Misleading information can distort individuals' expectations and compromise their trust in the therapeutic process. It can also lead to a worsening of some conditions when a patient blames themselves for a failure to achieve the promised results
Boundary Violations:
Unethical therapists may engage in inappropriate personal or sexual relationships with their clients, violating clear professional boundaries. This can cause severe emotional harm and exacerbate underlying conditions.
Exploitation for Financial Gain:
Unscrupulous therapists might exploit the vulnerability of individuals seeking healing by overcharging for services, recommending unnecessary sessions, or pushing additional treatments for financial gain.
Negligence and Lack of Monitoring:
Some therapists may fail to monitor the individuals adequately during the psychedelic experience, neglecting their emotional and physical safety. Negligence in providing appropriate care can lead to adverse outcomes. This can be especially true in group settings with inadequate support staff.
Failure to Handle Difficult or Challenging Experiences:
Ethical therapists are trained to guide individuals through challenging or difficult experiences during a psychedelic session. Unskilled or Unethical therapists may lack the skills or willingness to handle such situations, potentially causing psychological harm.
Lack of Confidentiality and Privacy:
Unethical therapists may breach confidentiality and privacy by sharing sensitive information about individuals or their experiences with unauthorized individuals, eroding trust by violating privacy rights could also exacerbate underlying mental illness.
Ignoring Individual Consent and Autonomy:
Unethical therapists might disregard an individual's expressed desires, boundaries, or concerns during the session, potentially leading to an undermining of autonomy and psychological damage.
Failure to Provide Integration Support:
Ethical psychedelic therapy includes integration sessions to help individuals process their experiences. Unethical therapists may neglect or minimize the importance of integration, leaving individuals to cope with the effects on their own.
Addressing unethical therapist behaviour is crucial for the responsible and effective use of psychedelic therapy. Establishing clear guidelines, standards, and regulatory frameworks, along with comprehensive training and ethical oversight, is vital to ensure the safety, well-being, and trust of individuals seeking this form of therapy. Individuals should feel empowered to report any unethical behaviour and seek support from professional and regulatory bodies.
AMAPP has very strict clinical governance policies in place to protect patients and provide clear expectations of how to address adverse events.
In the context of psilocybin and MDMA-assisted therapy, consent regarding touch is a critical aspect that warrants thorough understanding and communication. Touch can be a powerful tool in therapy, aiding in comfort, reassurance, and establishing trust. However, it must always be approached with respect for personal boundaries, autonomy, and consent. It is essential to clarify that any form of sexual touch or contact is strictly prohibited, potentially dangerous and unethical within the therapeutic setting.
1. Importance of Consent
Respecting Autonomy: Consent regarding touch upholds the principle of respecting an individual's autonomy and personal space during the therapeutic journey.
Empowerment: Obtaining consent for touch empowers you, the patient, to establish boundaries and communicate your comfort level with physical contact.
2. Types of Touch
Comforting Touch: Light touches for comfort and reassurance, such as a hand on the shoulder, are sometimes offered during challenging or emotional moments.
Therapeutic touch: Some touch can actually address physical discomfort during or after sessions. Not all therapists are skilled at somatic therapy.
Supportive Touch: Touch to support you physically or emotionally during the session, like holding a hand if needed or providing a hug if appropriate.
3. Guidelines for Touch in Psychedelic Therapy
Clear Explanation: Prior to the session, your healthcare provider will clearly explain the potential use of touch during the therapy and its therapeutic intent.
Consent Dialogue: A specific conversation about touch will occur before the session, ensuring you understand what types of touch may be used and allowing you to express your comfort levels and boundaries.
Ongoing Communication: Throughout the session, your consent will be consistently sought, and healthcare providers will regularly check in to ensure you are comfortable with the level of touch being offered.
Respecting Boundaries: Your stated boundaries regarding touch will be respected without question or judgment. If at any point you withdraw consent for touch, it will be honoured immediately.
Safety and Dignity: Touch will always be conducted in a manner that ensures your safety, dignity, and emotional well-being.
Non-Coercion: There will be no pressure to consent to touch. You have the right to decline any form of touch at any time during the session.
4. Changing your consent
Withdrawal of Consent: If you initially consent to touch and later decide you are no longer comfortable, you can withdraw consent at any moment. This will not impact your overall treatment or the therapeutic relationship.
After declining touch during the consent process, you may feel that you need it while under the influence of the drugs in the session. This eventuality needs to be discussed beforehand and possible alternatives discussed like pressure over a pillow or a weighted blanket etc. This way comfort can be offered without breaking the trust of your sober consent.
5. Recording and Documentation
Record Keeping: Any consent for touch or withdrawal of consent will be documented in your therapy records to ensure it is respected in future sessions.
Privacy and Confidentiality: These records will be handled with utmost privacy and confidentiality, shared only with those directly involved in your care.
6. Prohibition of Sexual Touch
Absolute Prohibition: Sexual touch, advances, or any inappropriate behaviour of a sexual nature are strictly prohibited and unethical within the therapeutic setting.
Reporting Mechanism: If you experience or witness any sexual misconduct or inappropriate behaviour, you have the right to report it to the appropriate authorities and to the organization overseeing the therapy.
AMAPP has very strict clinical governance policies in place to protect patients and provide clear expectations of how to address adverse events.
Underground psychedelic therapy refers to the unregulated, and often illegal provision of psychedelic substances in a therapeutic or healing context outside of established legal and professional frameworks. While many people (general population) may seek these drugs for personal growth, more and more people with significant mental illness (clinical population) are seeking these alternatives due to still very limited legal access in Australia, high costs or disillusionment with conventional mental health services. For this group especially engaging in unaccredited underground psychedelic therapy poses significant dangers and risks:
"Set” yourself up to fail
Planning to attend an underground therapist immediately adds a layer of anxiety to your "Set” (Meaning your mindset nurtured by your preparation) and may reduce the ability to fully let go into the experience. This is, for example because thoughts of what you will do if something goes wrong and you need urgent help are complicated by the fact that the therapist may be reluctant to call for help or you may be reluctant to call for help as you would both be admitting to breaking the law.
This removes an important layer of trust and reassurance which can make a negative experience more likely and a therapeutic one less likely.
Legal Consequences:
Underground psychedelic therapy involves the use of substances that are typically illegal or restricted in many jurisdictions. Engaging in such therapy can lead to legal repercussions, including fines, imprisonment, or a criminal record.
Lack of Safety Regulations:
While many underground therapists may have excellent training and experience, the fact that they operate outside regulatory frameworks means there can be lack of accountability, transparency, governance, peer review and pathways for reporting adverse events. This can increase the risk of unsafe practices. This includes inadequate screening of physical or psychological contra-indications, dosing inaccuracies, lack of medical monitoring, and improper preparation and integration processes.
Health Risks and Adverse Effects:
Without proper medical oversight, individuals may experience unexpected and adverse effects of psychedelic substances, such as increased anxiety, paranoia, hallucinations, and even potential physical harm. There have been deaths in Australia in these contexts.
Misleading Information and Lack of Education:
While many underground therapists are ethical and experienced, they may lack proper training and education, potentially disseminating misinformation about psychedelics, their effects, and therapeutic potential. This can mislead individuals seeking help and compromise their informed decision-making.
Psychological Trauma and Re-traumatisation:
While many underground therapists are ethical and experienced in the use of these drugs with healthy people, some may lack training and experience dealing with severe mental illness and may inadvertently retraumatize individuals (especially in the clinical population) by not providing adequate support or guidance during challenging psychedelic experiences, potentially exacerbating mental health issues, which they may not have been aware of due to inadequate preparation.
Exploitation and Financial Exploitation:
Individuals seeking alternative therapies may be vulnerable and desperate for healing. Unscrupulous underground therapists may take advantage of this vulnerability, charging exorbitant fees or exploiting individuals for financial gain without providing proper care.
Unethical Practices and Boundary Violations:
Unethical practices, such as violating personal boundaries, disregarding consent, or engaging in inappropriate relationships with clients can occur in any setting, however due to the lack of oversight in these settings as well as the complexities of client/therapist relationships, these may go unreported.
Lack of Integration Support:
Ethical psychedelic therapy involves integration sessions to help individuals process the experiences and insights gained during a session. Underground therapists may not offer this critical element of care, leaving individuals to grapple with the effects and potential trauma on their own.
Absence of Professional Oversight:
Underground psychedelic therapy lacks supervision and oversight from professional bodies or licensing agencies, raising concerns about the quality and ethical standards of the therapy being provided. This also makes them unaccountable for "professional” violations as discussed above.
Medical and Health Risks:
Psychedelics can have serious health risks, particularly for individuals with pre-existing medical conditions or those taking medications. The absence of proper medical evaluation and oversight in underground therapy can pose significant health risks.
In summary, unaccredited underground psychedelic therapy can carry substantial dangers due to legal consequences, lack of safety regulations, potential misinformation, psychological trauma, exploitation, and the absence of professional oversight. Individuals (especially those with mental illness) seeking psychedelic therapy should prioritize legal, accredited, and regulated options to ensure their safety, well-being, and adherence to ethical and professional standards.
See “Questions to ask a PAT therapist” to download an excellent information document from the Fireside project.
While most people do not change their underlying personality, psychedelic therapy can lead to profound shifts in personality, beliefs, and perspectives. While these changes can be incredibly positive and transformative for many individuals, they can also give rise to several complex issues and considerations:
Integration Challenges:
Individuals may struggle to integrate the insights and changes from the psychedelic experience into their daily lives. This can cause a discord between newfound perspectives and their previous sense of self, leading to confusion and difficulty adapting.
Identity Reconstruction:
Significant changes in beliefs, values, and personality can prompt a reevaluation of one's identity. It may be challenging to reconcile the post-psychedelic self with the pre-existing sense of identity, causing emotional distress and self-doubt.
Relationship Dynamics:
Changes in personality and beliefs can strain relationships with family, friends, or colleagues who may struggle to understand or accept the transformed individual. This can lead to isolation and a need to rebuild or find new social support systems.
Professional and Social Acceptance:
Altered beliefs and values may conflict with societal norms or professional expectations. Individuals may face prejudice, discrimination, or misunderstanding in academic, professional, or social settings due to these changes.
Cognitive Dissonance:
Individuals might experience an inner discord when their psychedelic-induced beliefs clash with their pre-existing belief systems. This dissonance can lead to inner conflict and emotional turbulence.
Social and financial:
If a person impulsively makes significant career decisions based on insights gained during psychedelic therapy, there may be a negative impact on financial wellbeing for them and dependants.
Psychological Vulnerability:
Rapid shifts in personality or beliefs can make individuals psychologically vulnerable. They may question the authenticity or stability of these changes, fearing they might revert to their previous state.
Integration Support:
Adequate support for integration, including follow-up therapy and community engagement, is crucial to help individuals navigate these changes. Without proper support, the transformative experience may not translate into sustained positive outcomes.
Ethical Considerations:
Therapists need to balance their duty to support the individual's transformation with ethical considerations, ensuring that changes align with the person's well-being and societal norms.
Long-Term Stability Assessment:
Ongoing assessment of the stability and permanence of the personality changes is essential to ensure they align with the individual's overall mental health and well-being in the long term.
Psychedelic therapy necessitates a delicate and thoughtful approach, ensuring individuals are adequately prepared for potential shifts in beliefs and personality. Post-treatment support and integration are critical for helping individuals process and navigate these changes constructively and responsibly.
