Alberta psychedelic-assisted psychotherapy framework

1. Introduction

Version followed: Alberta Mental Health Services Protection Act (2018) and Mental Health Services Protection Regulation (Alta Reg 114/2021) as amended in October 2022 (in force 16 January 2023); Government of Alberta Psychedelic Drug Treatment Services Standards (issued 17 January 2023; full text not drawn on, only its catalogue record and secondary summaries [uncertain]); CPSA psychedelic-assisted psychotherapy (PAPT) facility accreditation standards, read in their March 2023 consultation draft D2 (partly opened; the final standards, launched August 2023, go only to registered facilities [uncertain]); Alberta College of Social Workers (ACSW) PAPT practice guideline (June 2025); CPSA ketamine guidance (updated March 2026); provincial licensing page (published 17 September 2025).

What it is. This is a provincial regulatory framework, not a therapy model. It does not prescribe a psychotherapy method. It sets who may provide psychedelic-assisted psychotherapy for psychiatric disorders in Alberta, under what licence, oversight and safety conditions, and how incidents and complaints are reported. Alberta was the first Canadian province to regulate this area [source: Global News 5 Oct 2022; AHS Knowledge Bites 2023]. The designated drugs are psilocybin, psilocin, MDMA, LSD, mescaline (peyote), DMT, 5-MeO-DMT and ketamine [source: CPSA fact sheet 2023]. The framework applies only to treatment of psychiatric disorders. It excludes approved clinical research trials, use for pain, palliative care or other illnesses, and ketamine given outside psychedelic-assisted psychotherapy [source: CPSA fact sheet; Alberta licensing page].

Core idea of change (as the Alberta sources frame it). The drug is meant to catalyse psychotherapy; it is not given as stand-alone pharmacotherapy. Several preparation sessions build the relationship. During the drug session the therapist supports the client in a non-directive way. Integration afterwards is considered essential [source: AHS Knowledge Bites, St. Arnaud 2023]. CPSA's 2026 guidance requires an intentional link: the drug must be given as a central part of the psychotherapy, though the two need not happen on the same day [source: CPSA Ketamine Guidance 2026]. Safety is meant to come from layered medical oversight: a psychiatrist medical director, prescribing limited to psychiatrists (or physicians consulting one), no self-administration, monitoring of anyone in an altered state, licensing, accreditation and incident reporting [source: CPSA fact sheet; Alberta licensing page].

Legal and regulatory status (as of the sources' dates).

Alberta. Since 16 January 2023, a licence under the Act is required for any psychedelic drug treatment service, unless it is exempt. Clinical oversight must be by a psychiatrist. Licensed providers must post their licence at each facility and on their website, run a complaint process, and report critical incidents [source: Alberta licensing page 2025]. Under CPSA bylaws, PAPT may be delivered only in a CPSA-accredited medical facility that meets the CPSA PAPT standards [source: CPSA Ketamine Guidance March 2026; CPSA news Aug 2023]. Research trials need no licence but must be reported to the ministry once a research ethics board has approved them (Regulation s. 47) [source: Alberta licensing page]. The sources list no substantive amendments to the framework between 2023 and 2026 [uncertain: the 2024 consolidation of the Regulation].
Canada (federal). The provincial framework does not legalise these substances. They remain federally controlled. Alberta's own sources mention federal access routes only briefly: preparation may include helping a client through Health Canada's Special Access Program for psilocybin or MDMA [source: ACSW guideline 2025]. Section 56 exemptions and the current federal rules were not verified here [uncertain].
Other jurisdictions. These were not researched for this entry; see the sibling tabs in this family [uncertain].

2. Framework

The framework has two layers: the service (licence, facility, staffing) and the client pathway (referral, assessment, consent, preparation, drug session, integration, follow-up). The government Standards and the CPSA accreditation standards set requirements but do not fix session counts [source: CPSA draft D2; ACSW guideline].

Service layer

Licence. The provider applies to Alberta Mental Health and Addiction using the licensing form. The ministry can amend, suspend or cancel a licence, and decisions can be appealed to the Appeals Secretariat [source: Alberta licensing page]. Required policies cover safety and security, staff qualifications and training, records, and facilities [source: Alberta licensing page].
Accreditation. The facility registers with CPSA and must be assessed and accredited before it provides PAPT [source: CPSA news Aug 2023].
Medical director. A psychiatrist must be appointed medical director and oversees all clinical aspects of the service [source: CPSA fact sheet]. In the CPSA draft, the director is accountable for quality, safety, emergency preparedness, staffing and compliance; duties may be delegated in writing, but the director keeps ultimate responsibility (PAPT.1.1.9–1.1.11) [source: CPSA draft D2].
Who may deliver the psychotherapy. Psychiatrists, clinical psychologists, or regulated health professionals authorised to perform psychosocial interventions who meet the qualification or experience standard. They must be members of one of six colleges: occupational therapists, physicians and surgeons, psychologists, registered nurses, registered psychiatric nurses, or social workers [source: CPSA fact sheet; Global News]. As ACSW summarises the Regulation, a therapist needs: authorisation for restricted psychosocial interventions; a clinically related master's or doctoral degree; at least five years treating PTSD, mood or related disorders with evidence-based psychotherapies, as assessed by the medical director; and the PAPT training and experience the medical director requires [source: ACSW guideline 2025; Regulation wording uncertain].
Prescribing and administration. Only a psychiatrist, or a physician consulting a psychiatrist, may prescribe. The drug may not be dispensed or sold directly to the client, and the client may not self-administer. Administration is restricted to authorised regulated health professionals in approved settings. All of this belongs to the medical staff, not the psychotherapist [source: CPSA fact sheet].

Client pathway (phase / goal / format / criterion to move on)

Referral. Goal: the right clients enter through a physician. Format: in the CPSA draft, referral by the client's most responsible physician, who must not be affiliated with the facility, with a documented attestation that a psychiatric support programme has assessed the client for support before and after treatment. Self-referral is not permitted. Move on: referral accepted under the facility's acceptance and rejection criteria [source: CPSA draft D2, preamble and PAPT.6.2.1; CPSA news 2023 confirms a physician referral is needed].
Pre-screening and initial assessment. Goal: decide eligibility and exclude unsafe candidates. Format: a pre-screening form, inclusion and exclusion criteria with absolute and relative rejection criteria, then a full documented initial assessment; virtual assessment is allowed only under its own process (PAPT.6.2.1–6.2.2). Existing evidence-based treatments should be considered first [source: CPSA draft D2; CPSA fact sheet; ACSW]. Move on: the client is accepted and has a documented treatment management plan (PAPT.7.1.2).
Informed consent. Goal: consent specific to each intervention, obtained by each member of the team. Format: a written and verbal process before any service; refusals documented with reasons (Standards s. 4; PAPT.6.2.3, 6.2.5) [source: ACSW; CPSA draft D2]. Move on: consent documented, including consent to touch, recording and information sharing, and a named emergency contact recorded before the drug session [source: ACSW].
Preparation. Goal: rapport, trust and coping skills, and planning for safety and touch. Format: several meetings; no fixed number is set [source: ACSW; AHS]. Virtual or private-practice preparation is allowed only if the provider's policy and the medical director permit it [source: ACSW]. Move on: the team judges the client prepared [synthesis: no explicit readiness criterion was found].
Drug (medicine) session. Goal: a safe, supported experience. Format: in a licensed or accredited facility, with authorised personnel monitoring and caring for the client throughout the altered state, the treating physician available in person or by phone until discharge, and sessions video-recorded under a facility policy (PAPT.7.1.3, 7.1.5) [source: CPSA fact sheet; CPSA draft D2]. Discharge criteria and transport home are in sections of the CPSA standards not drawn on here [uncertain].
Integration. Goal: help the client understand and use the experience. Format: may start soon after the session or much later, and can continue over time, inside or outside the licensed facility as arranged and allowed by facility policy [source: ACSW; AHS].
Follow-up and outcomes. Goal: track safety and long-term benefit. Format: quality indicators include the medical director's regular review of safety and satisfaction, long-term outcomes, quality of life, symptoms and function, and long-term follow-up of all patients (PAPT.2.8.1). Treatment is halted when risks outweigh benefits [source: CPSA draft D2; CPSA 2026].

Session counts. None of the Alberta sources set the number of preparation, drug or integration sessions [uncertain]. Follow the facility's protocol and the medical director's plan.

3. Guiding principles

Medical oversight first. A psychiatrist medical director holds clinical accountability. In practice: the psychotherapist works inside the director's protocols and refers medical questions to the prescriber [source: CPSA fact sheet; ACSW].
Psychotherapy is integral, not an add-on. The drug must be intentionally part of the therapy. In practice: there should be a written psychotherapy plan linking preparation, the session and integration [source: CPSA 2026; AHS].
Stay within your scope. Non-prescribers do not choose, prescribe or administer the drug. In practice: never advise on the drug, the amount or the timing; send those questions to the prescriber [source: ACSW, citing the Health Professions Act].
Competence and qualification. Training, supervised practice and continuing education come before offering PAPT, with consultation and referral at the limits of competence. In practice: document your training and keep supervision going [source: ACSW].
Consent is intervention-specific and team-wide. In practice: each professional obtains and documents consent for their own part, including touch, recording and information sharing [source: ACSW; Standards s. 4 as cited by ACSW].
No sexual touch; touch only with consent and training. In practice: agree on touch, and its purpose, before the session; therapists without somatic or touch training do not touch clients, even if asked; plan alternatives such as a cushion or comfort object [source: ACSW].
Monitoring throughout the altered state. In practice: the client is never left unmonitored; who monitors is set by facility policy and staff qualification [source: CPSA fact sheet; CPSA draft D2].
Evidence honesty. Clients must not be told a treatment is proven when the evidence is limited. In practice: describe benefits and uncertainties in proportion to the evidence [source: CPSA 2026].
Evidence-based options first. In practice: document why existing treatments were insufficient before referring for PAPT [source: CPSA fact sheet; ACSW].
Cultural and spiritual responsiveness. In practice: offer access to spiritual care with the treating physician, and gender-separate services where culturally appropriate and possible (PAPT.6.2.4); the education ACSW recommends includes cultural humility and equity [source: CPSA draft D2; ACSW].
Transparency and accountability. In practice: licences are posted publicly, complaints go to the provider first and then to Compliance and Monitoring, and critical incidents are reported [source: Alberta licensing page].
Recognise heightened vulnerability. Altered states increase the client's suggestibility and dependence on staff. In practice: reinforce boundaries and follow prohibited-relationship standards strictly [source: ACSW introduction and Prohibited Relationships cross-reference; elaboration is synthesis].

4. Intervention inventory

The framework sets procedures, not techniques. This inventory covers every clinical and procedural step the Alberta sources assign to the psychotherapy team, plus the role of a psychotherapist outside the programme. The ACSW guideline names the preparation skills; the AHS presentation describes the session stance; the CPSA standards and government documents give the procedural items. Where a step has no Alberta source, it is marked [synthesis]. Anything about the drug itself (choice, amount, timing, administration, medical monitoring) belongs to the prescriber and medical staff and is not described here [source: ACSW; CPSA fact sheet].

4.1 Checking the provider and the pathway (any psychotherapist)

Purpose / when: whenever a client asks about psychedelic-assisted psychotherapy in Alberta, or names a clinic.
Steps: (1) Look the clinic up in the government directory of licensed psychedelic drug treatment service providers, and check that its licence is posted on site and on its website [source: Alberta licensing page]. (2) Confirm the clinic is a CPSA-accredited medical facility [source: CPSA 2023, 2026]. (3) Explain that entry is by physician referral, not self-referral [source: CPSA draft D2; CPSA news]. (4) If the service is not licensed and not an approved trial, treat it as outside the regulated framework (see 4.17).
Example language (illustrative): "Before we go further, let's check together whether this clinic is on the province's licensed list. In Alberta that's the first thing I look for."
Watch for: ketamine clinics offering treatment without psychotherapy, which may be exempt from the licence [source: Alberta licensing page]. Explain the difference to the client. Working when: the client can name the licence status and the referral route.

4.2 Referral coordination through the most responsible physician

Purpose / when: a client who may be suitable, after evidence-based options have been tried or considered [source: CPSA fact sheet; ACSW].
Steps: (1) With consent, write to the client's family physician or psychiatrist summarising diagnosis, treatments tried and response, and current risk. (2) In the CPSA draft, the referring physician must not be affiliated with the facility, and the referral must attest to an assessment by a psychiatric support programme for support before and after treatment [source: CPSA draft D2 preamble]. Ask the physician how that requirement is met locally [uncertain whether the final standard kept this wording]. (3) Offer to provide psychotherapy support before and after treatment, if you can [synthesis].
Example language (illustrative): "The clinic can only accept you through your doctor. With your permission I'll send a summary of our work so the referral is complete."
Watch for: the client approaching clinics directly; pressure from a clinic to recruit. Working when: the referral is received and the client has a named physician coordinating care.

4.3 Pre-screening and acceptance or rejection criteria (programme team)

Purpose / when: before any assessment appointment.
Steps: (1) Use the facility's pre-screening form and its written inclusion and exclusion criteria, which separate absolute from relative rejection criteria (PAPT.6.2.1) [source: CPSA draft D2]. (2) The psychotherapist contributes psychiatric and psychosocial history; the medical team screens medical and medication factors. Potential contraindications listed in the AHS presentation: a history of psychotic disorder (bipolar disorder and borderline personality disorder appear with question marks, i.e. unsettled); serious untreated cardiovascular disease; serious untreated seizure disorder; current serotonergic antidepressants (blunted effect, serotonin syndrome risk); current haloperidol; current lithium (seizures) [source: AHS Knowledge Bites 2023, presentation slides, not a regulatory list]. (3) Give the client verbal and written preparation instructions [source: CPSA draft D2]. (4) Document all decisions.
Example language (illustrative): "Some of these questions are about your health and medications. Those answers go to the medical team, who decide what's safe; I won't advise you on medication changes."
Watch for: clients under-reporting psychosis history, family history or medications to get access [synthesis]. Never advise stopping medication; that is the prescriber's decision. Working when: a screening outcome is documented with reasons.

4.4 Comprehensive initial assessment and treatment management plan

Purpose / when: after pre-screening, before consent to treatment.
Steps: (1) Carry out and document a full assessment (PAPT.6.2.2). (2) Build the treatment management plan: assessment findings, baseline condition, contributing factors, management interventions, and current and future treatment plans (PAPT.7.1.2) [source: CPSA draft D2]. (3) Record baseline measures, since the standards expect symptom, function, quality-of-life and long-term outcome tracking (PAPT.2.8.1) [source: CPSA draft D2]. Choosing instruments is left to the facility [uncertain]. (4) Confirm two patient identifiers before any treatment (PAPT.6.3.1) [source: CPSA draft D2].
Example language (illustrative): "Let's agree what change you hope for and how we'll measure it, so we can see whether this helped."
Watch for: vague or magical goals [synthesis]. Working when: the plan names concrete targets and follow-up points.

4.5 Intervention-specific informed consent

Purpose / when: before any service, and repeated by each team member for their own part [source: ACSW; Standards s. 4 as cited by ACSW; PAPT.6.2.3].
Steps: (1) Each professional explains their role, what they will and will not do, and the client's right to stop. (2) The prescriber discusses the risks and benefits of the specific drug; the psychotherapist refers drug questions back to them [source: ACSW]. (3) Inform the client of possible adverse effects, based on the facility's documented risk assessment (PAPT.6.2.5) [source: CPSA draft D2]. (4) Cover touch: whether it will be used and why (Standards s. 4(a)) [source: ACSW]. (5) Cover video recording: storage, retention and access [source: ACSW; PAPT.7.1.5]. (6) Get consent for sharing information with third parties, and explain the exceptions for urgent situations such as a medical emergency [source: ACSW]. (7) Record a named emergency contact before the drug session [source: ACSW]. (8) State the evidence honestly, including uncertainty and any off-label status [source: CPSA 2026]. (9) Document refusals with reasons and notify the requesting provider [source: CPSA draft D2].
Example language (illustrative): "My part is the psychotherapy before and after. Questions about the medicine itself go to Dr. X. You can withdraw consent at any point, including during the session."
Watch for: consent given under urgency or desperation; the client agreeing to touch to please staff [synthesis]. Working when: the client can explain in their own words what will happen and what they agreed to.

4.6 Touch agreement and alternatives

Purpose / when: during preparation, before any drug session.
Steps: (1) Ask what kinds of touch, if any, the client wants (for example hand-holding) and why [source: ACSW]. (2) If you have no somatic or touch-based training, explain that you will not touch, even if asked during the session [source: ACSW]. (3) Agree on alternatives: a cushion, comfort object or fidget item [source: ACSW]. (4) State clearly that touch never includes sexual touch [source: ACSW]. (5) Agree a non-verbal signal for withdrawing consent [synthesis]. (6) Document the agreement.
Example language (illustrative): "If you want support during the session, we can have a cushion or something to hold within reach. I won't touch you unless we've agreed it now, and you can change your mind."
Watch for: requests made in the altered state to go beyond what was agreed. Hold to the prior agreement [synthesis]. Working when: the agreement is written down and the client recalls it.

4.7 Cultural and spiritual care access

Purpose / when: clients for whom spiritual, religious or cultural framing matters.
Steps: (1) Ask about the client's beliefs and how they might shape the experience. (2) Offer access to spiritual care in consultation with the treating physician, and gender-separate services where culturally appropriate and possible (PAPT.6.2.4) [source: CPSA draft D2]. (3) For Indigenous clients, connect them with community-identified Elders or cultural supports chosen by the client; do not provide ceremony yourself [synthesis].
Example language (illustrative): "Are there spiritual or cultural supports you'd like involved, before or after?"
Watch for: staff imposing a spiritual interpretation [synthesis]. Working when: the client feels their framework is respected.

4.8 Preparation: building rapport and trust

Purpose / when: the first preparation meetings; ACSW describes preparation taking place over several meetings [source: ACSW; AHS].
Steps: (1) Review the client's history and the goals in the treatment plan. (2) Explore expectations, fears and past experience of altered states [synthesis]. (3) Explain the session environment and staff roles. (4) Explain that the session stance will be supportive and non-directive, encouraging trust, openness and acceptance of whatever arises [source: AHS].
Example language (illustrative): "Whatever comes up, the idea is to let it come, with us there. You won't be alone at any point."
Watch for: idealisation of the therapist or the drug [synthesis]. Working when: the client can voice fears openly and agrees to the frame.

4.9 Preparation: breathwork, mindfulness and self-soothing skills

Purpose / when: throughout preparation, to give the client ways to steady themselves during and after the session [source: ACSW lists breathwork, mindfulness and self-soothing strategies].
Steps: (1) Teach one or two grounding skills, such as slow paced breathing, body-scan awareness or attention to an anchor, and practise them in session [synthesis on specific skills]. (2) Use calming breathing, not intensive or hyperventilation-type breathwork. Screen as for other breath practices (cardiovascular disease, epilepsy, pregnancy, panic triggered by breath focus) [synthesis]. (3) Have the client practise between meetings and report back [synthesis]. (4) Agree how staff will cue these skills during the session [synthesis].
Example language (illustrative): "Let's practise this now, so that during the session a simple cue like 'breathe with me' already means something to you."
Watch for: mindfulness increasing anxiety or depersonalisation in some clients; switch to external grounding if so [synthesis]. Working when: the client can lower their own arousal on cue.

4.10 Preparation: identifying a support person ("compassionate witness")

Purpose / when: before the drug session; ACSW names this element [source: ACSW].
Steps: (1) Help the client choose a trusted person to support them around the session. (2) Clarify that person's role after the session, and record the emergency contact required before the session [source: ACSW]. (3) Get consent if the support person will be contacted [source: ACSW on information sharing].
Example language (illustrative): "Who could be there for you in the days after, someone who will listen without judging?"
Watch for: support people who are unsafe or controlling [synthesis]. Working when: a named, willing person is in place.

4.11 Preparation: suicidal ideation and safety planning

Purpose / when: in every preparation phase; ACSW lists discussion of suicidal ideation and safety planning [source: ACSW].
Steps: (1) Carry out a standard suicide risk assessment and document it. (2) Write a collaborative safety plan: warning signs, internal coping, social contacts, professional and crisis contacts, and reducing access to lethal means through storage or removal [synthesis following standard practice]. (3) Share the plan with the team, with consent. (4) Plan extra contact for the days after the session [synthesis].
Example language (illustrative): "Strong experiences can stir up dark feelings afterwards. Let's put a plan in writing now for what you'll do and who you'll call."
Watch for: rising hopelessness if the client sees this as a last chance [synthesis]. Working when: the plan is written, shared and rehearsed.

4.12 Preparation: set and setting, and intention

Purpose / when: late in preparation. The AHS presentation describes set (intention, personality, emotional state) and setting (physical, social, cultural) as primary influences on the experience and outcome [source: AHS].
Steps: (1) Help the client form an open intention linked to their treatment goals [synthesis on method]. (2) Describe the setting: lying down with eye shades and instrumental music, focused inward [source: AHS]. (3) Show or describe the room and the video recording if possible [synthesis]. (4) Go over what to do if the client wants to sit up, talk or stop [synthesis].
Example language (illustrative): "Hold your intention lightly. It points the way, but the session may go somewhere else, and that's all right."
Watch for: rigid intentions or expectations of a particular experience [synthesis]. Working when: the client feels oriented and able to let go of control.

4.13 Preparation: supporting federal access applications

Purpose / when: when access depends on federal authorisation; ACSW says preparation may include help with Health Canada's Special Access Program for psilocybin or MDMA [source: ACSW].
Steps: (1) Clarify that the prescriber makes the application. (2) Help the client gather the history and documentation the prescriber asks for [synthesis]. (3) Help the client cope with waiting or refusal [synthesis].
Example language (illustrative): "Dr. X handles the application. I can help you organise your history and deal with the waiting."
Watch for: distress or a slide into unregulated use if access is refused (see 4.17) [synthesis].

4.14 The drug session: therapist conduct within the regulated frame

Purpose / when: the medicine session, in the licensed or accredited facility.
Steps: (1) Medical staff handle administration and medical monitoring; the treating physician remains available in person or by phone until discharge (PAPT.7.1.3) [source: CPSA draft D2; CPSA fact sheet]. (2) Authorised personnel monitor and care for the client throughout the altered state; the client is never left unattended [source: CPSA fact sheet]. Staffing levels are set by facility policy according to the patient group and drug (PAPT.7.1.3, Appendix A.2 not drawn on here) [uncertain on staffing ratios and whether two therapists are required]. (3) The therapist's stance is supportive and non-directive: encourage trust, openness and acceptance; keep the client inward-focused unless they need contact [source: AHS]. (4) Use the touch and comfort-object agreement only as agreed [source: ACSW]. (5) Video recording follows facility policy [source: CPSA draft D2]. If a client has declined recording, a social worker consults the prescriber about whether benefits outweigh risks [source: ACSW]. (6) At the end of the session, consult the prescriber and team so the client's preferences are reflected and safety is addressed [source: ACSW]. (7) Discharge criteria and arrangements for getting home follow the facility protocol (PAPT.7.1.4 lists discharge and post-service instructions) [source: CPSA draft D2; specific criteria uncertain].
Example language (illustrative): "You're safe. We're right here. Let it move through you." — "Would it help to come back to the breathing we practised?"
Watch for: severe agitation, aggression, dissociation or psychotomimetic effects; the CPSA draft requires pre-arranged access to clinicians who can manage these (PAPT.1.1.6) [source: CPSA draft D2]. Hand over to medical staff at once. Working when: the client stays oriented to safety and the staff, even through difficult material.

4.15 Integration sessions

Purpose / when: after each drug session, early and over time; the AHS presentation calls integration essential [source: AHS; ACSW].
Steps: (1) Hold a first integration contact soon after the session, inside or outside the facility as policy allows [source: ACSW]. (2) Invite a free account of the experience, then explore its meaning in relation to the client's goals and life [source: AHS: patients discuss concerns and place insights in context]. (3) Turn insights into concrete behavioural steps, and continue the evidence-based psychotherapy the client was already receiving [synthesis]. (4) Re-check risk and the safety plan [synthesis]. (5) Use group integration where the facility offers it; ACSW lists individual and group integration in recommended training [source: ACSW]. (6) Record outcomes for follow-up (PAPT.2.8.1) [source: CPSA draft D2].
Example language (illustrative): "What from the session feels most important now? What would it look like to act on it this week?"
Watch for: grandiosity, persistent perceptual changes, sleep disruption, new or worsening suicidality, or destabilising memories. Report these to the medical director [synthesis]. Working when: insights translate into changes in symptoms or function.

4.16 Adverse events, critical incidents and the duty to notify

Purpose / when: any event that caused or threatens serious injury or death, or any situation that may jeopardise service delivery or patient safety [source: Alberta licensing page].
Steps: (1) Ensure immediate safety and medical care. (2) Tell the medical director at once; facilities halt treatment where needed, with defined authority for resuming it (PAPT.2.7.1) [source: CPSA draft D2]. (3) The licensed provider works through the government decision document, completes the Critical Incident Reporting and Duty to Notify form, and submits it through the compliance-monitoring portal [source: Alberta licensing page]. (4) Follow the CPSA reportable-incident policy and the disclosure policy [source: CPSA draft D2]. (5) Meet the reporting duties of your own college [synthesis].
Example language (illustrative): "Something happened that we're required to report. I'll explain what it means for you and what support you'll get."
Watch for: pressure to keep incidents in-house [synthesis]. Working when: the report is made on time and the client is supported.

4.17 Outside the programme: harm reduction and integration support

Purpose / when: a client who has used, or intends to use, psychedelics outside a licensed service or trial. Your role is harm reduction and integration, never facilitating illegal use [synthesis].
Steps: (1) Assess without judgement: what, where, with whom, and any after-effects; psychiatric and medical history; medications [synthesis]. (2) Educate in general terms: risks with psychosis or bipolar history, cardiovascular and seizure conditions, and interactions with serotonergic antidepressants, lithium and some antipsychotics (the risk categories named by AHS) [source: AHS; framing synthesis]. Do not give any dosing or sourcing information. (3) Point to legal routes: licensed Alberta providers through a physician referral, clinical trials, and federal access through a prescriber [source: Alberta licensing page; ACSW]. (4) Safety plan and crisis contacts [synthesis]. (5) Offer integration of past experiences within your usual therapy [synthesis]. (6) If a clinic is operating without a licence, raise concerns with Compliance and Monitoring; the provincial abuse line exists for abuse concerns [source: Alberta licensing page].
Example language (illustrative): "I won't help arrange this, but I want you safe. Can we look at your health history and medications, and the legal routes available?"
Watch for: concealed use, unlicensed retreats, or exploitative facilitators [synthesis]. Working when: the client discloses openly and takes up safer options.

4.18 Complaints and records

Purpose / when: throughout the service.
Steps: (1) Tell clients about the complaint process: raise concerns with the provider first, then with Compliance and Monitoring if unresolved [source: Alberta licensing page]. (2) Keep records showing evidence-informed decisions, consent (including for off-label use), ongoing review of benefit and risk, and monitoring and follow-up plans [source: CPSA 2026]. (3) Follow facility rules on storing and retaining video recordings [source: ACSW; PAPT.7.1.5].
Example language (illustrative): "If anything about your care worries you, here's how to raise it, and you won't be penalised for doing so."
Watch for: clients who are reluctant to complain about staff they depend on [synthesis].

5. Handling problems

The Alberta sources deal mainly with governance. Most of the guidance below is therefore [synthesis] unless a source tag is given.

Client is ineligible or rejected at screening. Explain the reason as the team documented it, review evidence-based alternatives, and keep up your therapy [synthesis]. Refusals are documented and the requesting provider is notified [source: CPSA draft D2]. Watch for disappointment turning into unregulated use (4.17) [synthesis].
Client presses you about medication changes or the drug (amount, which drug, combinations). Decline: this is outside a non-prescriber's scope [source: ACSW]. Send the question to the prescriber and document it [synthesis].
Stuck or ambivalent in preparation. Explore what the ambivalence is about; postpone the session rather than push through. Consent is ongoing and can be withdrawn [synthesis; consent principle from ACSW].
Overwhelm during the session (panic, terror, agitation, dissociation). Use the cues rehearsed in preparation, reassurance, and contact within the touch agreement. Hand over to medical staff, and escalate to the pre-arranged clinicians who manage severe agitation, aggression, dissociation or psychotomimetic effects [source: CPSA draft D2 PAPT.1.1.6; responses synthesis]. Report it as a critical incident if it meets the threshold [source: Alberta licensing page].
Requests for touch, or boundary testing, in the altered state. Hold to the prior agreement. If unsure, choose no touch. Never sexual touch [source: ACSW]. If any boundary violation occurs, a report to the regulator and a duty-to-notify assessment are required [synthesis on process; licensing page on duty to notify].
Client declines video recording. Respect the refusal and consult the prescriber on benefits and risks before going ahead [source: ACSW]. Note that the CPSA draft expects a recording policy covering all sessions, so the facility may not be able to proceed [source: CPSA draft D2 — uncertain how the final standard handles refusal].
Post-session destabilisation (new suicidality, persistent anxiety, perceptual changes, emergence of traumatic memories). Bring integration contact forward, re-assess risk, activate the safety plan and inform the medical director. Pause further sessions until the team reviews [synthesis; halting treatment when risk outweighs benefit: CPSA 2026; CPSA draft PAPT.2.7.1].
Rupture with the team (feeling abandoned, misled, or that the drug "failed"). Repair openly, revisit what consent and the evidence actually promised, and make clear that integration is still useful [synthesis; honesty about evidence from CPSA 2026].
Non-adherence (missing preparation or integration). Preparation is a requirement, so reschedule the drug session. Make sure there is an integration plan before the session date [synthesis].
Inflated expectations or grandiosity after a session. Ground insights in behaviour, delay major life decisions, and screen for hypomania [synthesis].
Client wants integration with you while being treated elsewhere. Get consent to coordinate with the facility's team, clarify that the facility leads the programme, and stay within your competence and liability coverage. ACSW encourages consulting insurers and recommends at least $5,000,000 in liability coverage for social workers [source: ACSW].
Dual relationships or conflicts of interest (for example, a therapist who refers clients to a clinic that employs or pays them). Disclose and avoid. Facility policies must cover conflicts of interest [source: CPSA draft D2 PAPT.1.1.12; ACSW Prohibited Relationships]. In the draft, the referring physician must not be affiliated with the facility [source: CPSA draft D2].
Unlicensed or exempt services marketed as therapy (for example, ketamine without psychotherapy, retreats, underground facilitators). Explain the licence status, check the provincial directory, and report concerns to Compliance and Monitoring [source: Alberta licensing page; advice synthesis].
Cultural or spiritual conflict (a client wants a ceremonial framing). Offer spiritual care through the facility [source: CPSA draft D2 PAPT.6.2.4]. Refer to community authorities for ceremony; do not provide it yourself [synthesis].
Not addressed in the sources: session counts, staffing ratios, two-therapist rules, discharge criteria, transport home, and specific outcome instruments. Follow the facility protocol and medical director [uncertain].

Sources

Sources:

Further reading (not drawn on): Government of Alberta (2023), Psychedelic Drug Treatment Services Standards; Mental Health Services Protection Act (SA 2018) and Mental Health Services Protection Regulation (Alta Reg 114/2021, as amended 2022); CPSA final PAPT accreditation standards (2023); College of Alberta Psychologists (2025), PAPT guidance (cited by ACSW). Pages refused: open.alberta.ca/publications/2021_114 and the CPSA PAPT accreditation information page.

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