Psychedelic-assisted CBT and motivational enhancement

Domain VII · Transpersonal, psychedelic & altered states · Bogenschutz, Forcehimes, Johnson · 2014

What it is

"Psychedelic-assisted CBT and motivational enhancement" is not one named therapy. It is a family of research protocols in which a standard addiction psychotherapy is the main treatment. That therapy is either Motivational Enhancement Therapy (MET) or manualised CBT for smoking cessation or alcohol…

Format

• Team format (alcohol model). Two therapists form a dyad.
• The PSI therapist delivers preparation, attends medication sessions and leads debriefing.

Who practises it, and how they are trained or regulated

• Who this guide is for. In 2026 these protocols are delivered lawfully only inside approved research or regulated programmes. A therapist outside such a programme can use the MET/CBT and integration components with clients. For clients who use psychedelics elsewhere, the therapist's role is harm reduction and integration (section 5), never facilitation.
• Legal and regulatory status (as of the sources' dates).
• US states: Oregon runs licensed service centres with state-trained, licensed facilitators; licensing began in 2023, clients must be 21 or older, and no medical referral is required. Colorado runs a Regulated Natural Medicine Access Program with licensed healing centres. New Mexico passed a Medical Psilocybin Act in 2025. Utah has run a hospital-based pilot since 2024. Washington has a University of Washington pilot.

Evidence status, as the guide reports it

• Version followed: the core is the Bogenschutz and Forcehimes (2017) two-therapist model for psilocybin-assisted treatment of alcohol dependence. It pairs a Motivational Enhancement and Taking Action (META) therapist with a psilocybin preparation and integration (PSI) therapist, as used in the UNM…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• a statement written for others rather than for themselves.
• missing entries. Simplify the format rather than criticise.
• unprocessed trauma or current crises that may need attention before the session.
• values chosen to please the therapist, and guilt spirals. Reflect strengths as well as gaps.
• over-high expectations of a cure, and catastrophic fears. Reflect both and normalise uncertainty.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.