Psychedelic Retreats
An overview of common vetting criteria
Gerard Aresona made significant contributions and edits to the original version of this essay published at https://www.psychedelicretreat.info.
Disclaimers
This document does not represent the opinions of anyone other than the listed authors. It is for informational purposes only and should not be taken as medical or legal advice.
Terminology
Psychedelic Retreat - A paid-for and professionally facilitated program in which participants are supported in their personal growth or healing through the use of psychedelic medicine for an extended period of time (at least two days) away from their routine responsibilities. A retreat may occur in a 1-on-1 or group setting.
Psychedelic Retreat Center - Any institution offering psychedelic retreats which may include churches, medical clinics, and dedicated retreat centers with traditional plant medicine healers.
Facilitator - Any individual who is professionally assisting participants within the context of a psychedelic retreat. These individuals may or may not hold modern professional certifications. They are expected to have several years worth of experience hosting retreats or be training under the supervision of someone who does.
Purpose
This document aims to collect criteria that can be used to evaluate the fitness of a psychedelic retreat center for a given person, especially those requiring higher standards of care such as individuals with complex PTSD.
Our Motivation
Individuals may choose to access psychedelic medicine through a variety of above ground and below ground contexts. Beginning in 2023, residents of Oregon will be able to purchase and consume psilocybin with a state-licensed practitioner. More recently, Colorado passed a ballot initiative which will permit access to psychedelic medicine within both regulated and decriminalized, non-commercial contexts. Many people will prefer access through a regulated model such as one-on-one treatment in a clinical setting with a certified therapist. Others–maybe even the majority–will not due to lack of access, financial barriers, or personal preferences. For these reasons, we expect demand for psychedelic retreats of all kinds to increase. Unfortunately, perspectives on how to evaluate offerings are cloistered and scarce. We are motivated to collect and present a diversity of perspectives on evaluation criteria of psychedelic retreat offerings to better support individuals with complex PTSD and other ailments which require a higher standard of care.
Retreat Center Evaluation Criteria
Code of ethics
A code of ethics is a document that explicitly states an ethical framework which an organization can make a commitment towards adopting. These frameworks set forth values, principles, and standards to which professionals aspire and by which their actions can be judged. They also assist members of an organization in understanding the difference between right and wrong behavior in the context of their professional work.
If a psychedelic retreat center adopts a code of ethics, this can help guide expectations related to the kinds of interactions participants can expect to have with facilitators and how mediation would transpire in the event a participant felt harmed in the course of their experience at the center. Having some understanding of expected behaviors, boundaries, and incident response process is the only way a participant can provide informed consent.
While a code of ethics is only a document and the historical actions of its adopters must be judged directly, they can provide a useful signal regarding the commitments a center and its facilitators are making to participants and the broader community of which they are a part.
Working agreements are similar in spirit to a code of ethics and can be taken as reflective of a code of ethics even if the ethical framework motivating them is not explicitly outlined.
Resources:
Referrals and reviews
The most critical step in assessing a retreat center is to verify the information provided by the center in the form of referrals, reviews, and testimonials of past participants. Centers go through changes in ownership or management which can impact facilitation, affordability, and virtually every other aspect of a center’s offering. Therefore, even if a retreat center has acquired a strong reputation and become regarded as a trustworthy institution, it is important to continue to verify the activities of a center by continuously collecting reviews.
Preparation and integration support
There is strong evidence in the clinical research that psychedelic medicine is much more effective when paired with coaching or therapy. This support can come in many forms but is typically divided into pre- and post-treatment phases, referred to as preparation and integration respectively. The quality of preparation a participant undergoes (typically with the support of the facilitator) contributes to an openness and receptivity to accessing a spiritual dimension within their experience, and clinical research points to a very strong correlation between the strength of the mystical experience one may have on psychedelics and beneficial outcomes such as a reduction in anxiety, depression, or addictive cravings. After the retreat, the integration phase supports a participant in making adjustments in mindset and lifestyle to best accomplish their goals.
Preparation
Preparation for a psychedelic retreat is a blend of guided personal work and practical logistics. Before guided preparation begins, a center should perform an intake and screening process to set initial expectations, collect information, and check for contraindications amongst participants.
Participants are generally expected to follow a protocol leading up to the retreat that may include 1-on-1 counseling, journaling, adjustments to diet, weaning off of certain drugs and prescription medications, and lifestyle changes like reducing use of social media and other stimulating activities. A retreat center should regularly check-in with participants via scheduled touch-points to detect if a participant is following or falling off protocol.
Integration
Psychedelic experiences can result in encounters with new information or aspects of one’s personality or situation that are troubling and difficult to come to terms with. Sometimes this is referred to as “shadow material”. Integration is the process of staying conscious of and connected with challenging material that arises during a psychedelic experience in order to support gradual, long-lasting improvements to health and well-being.
Dr. Ido Cohen from The Integration Circle provides a good framing for integration:
“The [psychedelic] experience can often open and allow us access to our personal and collective unconscious. This means that we have an encounter with shadow - we make initial contact with new information, or we reconnect with familiar shadow material. When we encounter shadow material, it’s like meeting a new person - while I might have ideas about them, feelings, sensations, it does not mean I know them or have a relationship with them. This is where there is a vast misconception in the psychedelic space, which breeds ideas of ‘healing trauma’ after one retreat or a heroic dose. While symptom reduction after one experience is very possible, it does not mean healing or curing. Shadow or trauma can not be ‘cured’ in that way. Only through an ongoing relationship and inquiry, one learns the origins, influences, needs and methods of the shadow - then, one can learn to change their relationship with it, pave new pathways of working with and responding to it.”
A retreat center should offer some form of support for integration immediately following a psychedelic experience and for at least several days afterwards. As in preparation, a center should have a well defined process for checking in with participants to monitor for and respond to negative outcomes.
Integration work can take many forms, all of which benefit from curiosity over criticism and involve self-inquiry typically facilitated by a guided practice like journaling, scanning meditation, or mindful movement. A daily practice of bringing awareness to and writing down sensations, feelings, thoughts, and images especially those that are challenging ought to be encouraged.
Ideally participants are provided personalized coaching or some other form of accountability to encourage them to stay connected with and make commitments towards their integration process.
Resources
Facilitation
Facilitation refers to the quality and degree of active engagement that facilitators take with participants during a psychedelic retreat. Support before and after a retreat are addressed in the preceding section on preparation and integration.
Facilitation exists within a broad multi-dimensional space. Facilitation can be lightweight (i.e. more akin to witnessing) or actively engaged (i.e. a more guided experience). Facilitators may work with others or alone. Some facilitation may be oriented at elevating the group through celebratory ritual while other forms may focus on making space for individual grief and processing of trauma. Facilitation may involve music, speaking words of encouragement, chanting, compassionate silent witnessing, dancing, and many other forms of supportive presence.
Psychedelic medicine provides one way of tapping into our innate capacity to self-regulate, self-repair, and re-establish balance in our whole being (mind, body, and spirit). These medicines also come with their own set risks. Psychedelics are non-specific amplifiers, boundary dissolving, and have the potential to be physically and emotionally unsettling at high doses. These qualities impart risk but also contribute to their effectiveness as a form of therapy; however, when used irresponsibly or combined with poor facilitation, psychedelics can lead to harm. This is especially true for individuals who have a personal or family history of mania or schizophrenia. A few psychedelics also have physical risks of cardiotoxicity (e.g. ibogaine) or pharmacological interactions with other substances (e.g. ayahuasca which includes an MAO inhibitor). A facilitator’s first responsibility is to minimize the risks and potential harms associated with using psychedelic medicine for a given individual.
Psychedelics temporarily dissolve boundaries between individuals, and facilitators assume a position of authority and power throughout a retreat; therefore, participants are especially vulnerable to any facilitator who would abuse this dynamic and take advantage of a participant’s altered state. Facilitators who work alone are less likely to be held accountable for mistakes or abuses and extra diligence is required during evaluation. On the other hand, a group dynamic between multiple facilitators or between facilitators and staff can be in a state of disrepair and negatively impact a participant’s experience as well.
Facilitators typically bring a host of additional skills, trained or studied perspectives, and healing modalities outside of psychedelic medicine to aid them in their work. They may have also trained under a specific cultural lineage that produces a unique ceremonial container. These containers vary significantly and the diversity lends itself to helping people at different moments of their lives. Participants can benefit from a celebratory, community-oriented, mobile ceremonial container; although, individuals who have very complex trauma or deep depression with high levels of compartmentalization may achieve more of a therapeutic benefit from a container which facilitates deeper personal exploration, higher doses of medicine, while seated and mostly silent in one’s own process or engaged one-on-one with a facilitator who may sing, chant, and communicate energetically with individual participants as needed. In the Western world, these types of ceremonies are often directly or indirectly inspired by the Shapibo traditions of Peru and the Mazatec traditions of Mexico and require very skilled facilitation that generally requires years (if not decades) of training under observation of a more experienced and mature facilitator. The following section will explore the concept of the container in more depth.
The following questions can help provide an account of a facilitator’s background, inclination, and skill set.
Questions for facilitators
These questions can be directed towards members of your community who have previously worked with the facilitator, which may ultimately be your most reliable source of information.
What style or approach do the facilitators offer (clinical/therapeutic, religious/spiritual, etc.)?
Does the facilitator have a spiritual background and how is this incorporated into their practice?
How long have facilitators and other staff at the retreat center been working together?
Is there a healthy dynamic between the staff at the retreat center?
What is the facilitator to participant ratio?
What is the facilitator gender balance?
What other individuals or institutions hold the facilitators accountable for misconduct?
What level of training have facilitators received? How many years? Was the training specifically trauma-informed and directed towards healing psychological and emotional trauma?
Do the facilitators have previous experience with veterans or first responders?
Do the facilitators engage from a place of apparent care, genuine respect and discerning integrity?
Are they open, transparent, sincere, attentive, capable of listening, relatable, and trustworthy?
What is their specific background in working with a particular medicine? Are they knowledgeable and intimately familiar with their particular protocol or ceremony?
Do they have particular expertise, background, training (e.g., historical sacred plant work, clinical or therapeutic psychology training, relevant pastoral education), or are they working in an apprenticed tradition or lineage?
Do they respond to questions with clear information about the retreat, including discussion of ethics, boundaries, preparation and integration?
Do they have any other background or skill set that aids them in their work or other healing modalities that they utilize?
How long have the facilitators been practicing?
How many individuals has each facilitator served or worked with?
To what degree do the facilitators engage with participants during the psychedelic experience? Do they actively engage even if not called for or are they passive witnesses unless help is requested?
Do the facilitators take small or large doses of medicine with participants during the retreat? (This typically only happens in the context of a religious or traditional ceremony).
Are the facilitators during the retreat also involved in preparation, screening, safety and/or integration support?
What type of integration support is offered by facilitators during the retreat?
Resources
Fireside Project: Questions to Discuss with a Psychedelic Facilitator
Fireside Project: Ten Warning Signs When Selecting a Psychedelic Facilitator
Container: setting, ceremony and medicine
The term container is expansive and roughly corresponds to the “setting” component of “(mind)set and setting.” It encompasses the physical and environmental conditions of the space in which the retreat is held, the overall balance and feel of the composition of participants and facilitators, the logistical schedule and flow of events that take place, and the adaptability of facilitators to changing circumstances. These facets can vary significantly between modalities and traditions. The flow of a guided psychotherapeutic or clinical session will look very different from a traditional plant medicine ceremony. Evaluating these conditions is partially a subjective affair: participants of a retreat can walk away with very different experiences and assessments of the overall “strength” of the container. Longitudinal in-depth reviews or interviews are the ideal mechanism for collecting this subjective component of an assessment as perspectives can and often change over time. Questions that can be asked include:
Did the facilitators conduct themselves with professionalism?
Did the retreat feel controlled and safe even during moments of uncertainty or confusion?
Did the medicine feel clean and strong as it was absorbed?
Did the flow of the retreat feel natural and unforced?
Did facilitators adapt well to unforeseen circumstances?
Did participants feel invited to explore and express difficult emotions?
As stated, containers can look very different. Within traditional plant medicine ceremonies, there is a considerable variety of forms. An outline should be communicated well in advance (prior to any monetary exchange) to set expectations for the types of behavior and participant contributions that are welcome or discouraged. Examples include helping other participants, singing, dancing, burning incense, or support in other ways. This communication should ultimately take the form of explicit “agreements” that participants agree to adhere to. Example agreements include: asking for help if needed, no touching other participants, no sexual activity of any kind, no speaking, accepting the direction of facilitators, and no leaving the property or premises. A failure to communicate these shared expectations and agreements well in advance can confuse participants and lead to less favorable outcomes. In some cases participants may be so frustrated by a mis-match in expectations that they can become problematic during the retreat and affect other participants as well. These situations can generally be avoided by clear communication well in advance of the retreat.
Contingency planning and emergency preparedness
An earlier section on preparation and integration support presents areas of focus for risk mitigation while the discussion on a code of ethics describes the importance of clear communication for establishing shared expectations. Nonetheless, no amount of preparation and risk mitigation can make an environment completely safe. Accidents and unanticipated events can lead to emergencies that centers must be prepared in advance to deal with in the form of contingency plans and appropriately trained staff.
Centers should have a well-defined protocol for detecting and escalating medical emergencies. At a minimum, facilitators should be trained in basic first aid and CPR. While almost all classic psychedelic substances (5HTP agonists) have no clinically relevant toxic dose, a very small number (e.g. ibogaine) can be life threatening if improperly administered. If a psychedelic retreat center does not have medically trained staff on-site or readily available in the event of an emergency, participants should be well informed of this difficulty in accessing medical care should the need arise.
On extremely rare occasions, a participant may become so agitated that restraint may be necessary to protect the safety of the participant as well as others. A center that has facilitators on staff with training in nonviolent means of restraint demonstrates a high level of commitment to safety.
In general, centers should have operating procedures and escalation protocols in place for various worst-case-scenarios (e.g. an intoxicated, aggressive, non-responsive, or missing participant).
Financial considerations
The affordability of a retreat is a significant limiting factor for most individuals. Flexible payment options such as tiered pricing systems and payment plans as well as scholarships should be investigated. Additionally it must be considered whether the center is able to make appropriate and responsible screening decisions based on their financial structure. Centers which exclusively provide psychedelic retreats and have no alternative sources of income may be compromised in their ability to screen for participants and provide safe and strong containers due to an overriding financial imperative and incentive to sustain their operations.
Reciprocity and sustainability
Every relationship provides an opportunity to shift into a mindset of gratitude, gifting, receiving, and reciprocity. By embodying this mindset in our actions we support a culture where others feel more comfortable doing the same (in contrast with cultures that are exploitative and transactional). Psychedelic medicine provides direct access to a spiritual dimension that provides perspective into how dependent we all are on each other, our communities, and the natural systems which support us. Honoring these relationships and connections is an essential component of individual and community healing and also directly tied to economic and agricultural practices that are more sustainable and often regenerative.
Furthermore, there are Earth-based traditions, especially amongst indigenous communities, that have known and practiced these relationships for hundreds and sometimes thousands of years as part of a spiritual practice incorporating entheogenic sacrament. As psychedelics become more widely discussed and sought after in our society, it’s essential that access to the environment and to natural medicines is preserved within these communities, from whom we can learn a great deal about how to respect and learn from our work with psychedelics especially medicinal plants and fungi, which are often viewed as sacred teachers within these groups. We can also learn from these communities ways of preparing to work with and integrate powerful psychedelic experiences, ways of approaching restorative justice, and ways of being in harmonious relationship with the natural world.
For all of these reasons and more, it should be investigated whether retreat centers have sustainability goals, commitments to supporting their local communities, demonstrated respect for any borrowed indigenous tradition, and reciprocity initiatives to support any groups from which medicine has been sourced or traditional knowledge has been shared. At a minimum, the sources of medicine should be known in order to minimize harm that may arise from its production or acquisition. Investigators should also be on the lookout for superficial efforts by centers to present as valuing reciprocity or sustainability (i.e. greenwashing).
Resources
Acknowledgements
We appreciate the time, efforts, and perspectives generously offered by members of the Heroic Hearts Project team, especially Jesse Gould.