How We Can Hurt: Psychedelic Psychotherapy and Harm

New providers entering the field of psychedelic-assisted psychotherapy often underestimate the complexities of working with these powerful substances. While the enthusiasm for psychedelics is growing, concerns about inadequate training, improper screening, and insufficient follow-up care remain under-addressed. What are the essential skills, ethical considerations, and safeguards clinicians must adopt to ensure safety and successful patient outcomes in this emerging field?

Psychedelic psychotherapy provider and therapist Derek Rinaldo emphasizes the importance of peer support, supervision, and self-regulation for clinicians working in this space. Providers should build robust referral networks for clients requiring additional psychiatric or medical care and develop strong therapeutic relationships to navigate complex cases. While psychedelic therapy can provide immense healing benefits, it can also cause harm if executed improperly, so Derek urges clinicians to prioritize ethical integration practices, safety, and continuous learning to guide clients through their psychedelic journeys responsibly.

In today’s episode of Living Medicine, Dr. Signi Goldman interviews Derek Rinaldo, MA, LCMHC, and LCAS-A, of Clear Life Counseling, about the risks associated with psychedelic-assisted psychotherapy. Together, they explore the potential downfalls of integration, the categories of harm in psychedelic psychotherapy, and the difference between authentic therapeutic outcomes and recreational psychedelic use.

This episode is brought to you by the Living Medicine Institute.

LMI is a training, resource, and membership program educating providers about the legal and safe use of psychedelic-assisted psychotherapy.

To learn more or participate, visit https://livingmedicineinstitute.com.

Intro 0:03

Welcome to the Living Medicine podcast, where we talk about ethical medical use of psychedelic psychotherapy, teaching skills, examining the issues and interviewing interesting people. Now let’s start today’s show. 

Dr. Signi Goldman 0:19

Hello everyone. Thanks for joining us again. This is Signi, one of your hosts for Living Medicine. And as you guys know, if you’ve been listening along, our audience is particularly people who are interested in psychedelic medicine, but from the clinical side. So though we’ve interviewed researchers and people on the policy side, you guys know that our mission is particularly to speak to clinicians and people who are going to be actually doing the work. So I’m really excited today to talk to someone who has some of the most important messaging in the field right now, for those of you who are starting out in psychedelic assisted psychotherapy. So I want to introduce Derek Rinaldo, and I’ll let him talk a little bit about himself. Derek is a long time psychedelic medicine practitioner. He’s also a breath work provider, and can speak a little bit about that if we have time. He is certified through the Living Medicine Institute program with us, as well as maps and lyco’s available trainings. And he’s also has holds a certificate in psychedelic therapy and research through the California Institute of integral studies. Derek has a private practice, and he has been heavily involved in a long time, also with a sort of peer support for providers in the psychedelic space. So thank you for coming on. Really appreciate having you.

Derek Rinaldo 1:35

Thanks, Signi.

Dr. Signi Goldman 1:37

So we are planning to talk a little bit today about a topic that you and I both agree is underrepresented in the conversations out there. For our audience’s sake, I’ll remind you that I’m one of the founders and runners of a training program for therapists that are getting into psychedelic medicine, and so we see cohort after cohort of very enthusiastic people who are often very skilled clinicians, but want to get into this space. And there’s a huge amount of enthusiasm, and there’s a huge amount of sort of jumping in. And one of the things you and I have talked about is that we noticed that in the public sphere, and also even in some these conversations, in the programs themselves, there’s often not enough discussion about the dangers. And I think we have a shared concern about new providers, kind of jumping into the space, yes, not quite ready to before encountering these kind of situations or also doing harm because they haven’t thoroughly been prepared or thought through what harm looks like on psychedelics. So, but why don’t we start by you telling us a little bit about yourself and how it comes to be that you and I are the ones having this conversation,

Derek Rinaldo 2:59

well, a little bit about myself. So I have as a as a youth, I dabbled around in psychedelics and learned a lot. Some of it was just being out in the woods with friends and going to festivals here and there, and and and always it seemed like I walked out of there, sometimes with difficult experiences, but just a lot of personal growth. And just as years went on, I just I realized how impactful has been in my life, and seeing it being impactful in other people’s lives. And as I became a licensed mental health therapist, it was an area that I really wanted to to really explore and get training in and and do it right. So that’s sort of where this all kind of started. I had started up peer support group with other other therapists who are also working with psychedelics and ketamine use particularly, and so it’s been really helpful to learn with other therapists and people in general. So in my private practice, gosh, over the past seven or eight years, I’ve probably had five or six people a year contact me because they’ve had what they’ve called really bad trips and persistent problems afterwards, once afterwards, or just not getting a whole lot out of it like they wanted to. And so some of that post experience integration, you know, has been from, let’s get more out of this to wow. We’ve really got to deal with some adverse effects. So it’s been really concerning for me. 

Dr. Signi Goldman 4:50

That’s interesting. There’s almost two categories, people who’ve been harmed, if just to use that word, and then others who are maybe haven’t been skillful. Fully prepared or assisted with integration, yeah, and are kind of just dangling out there without any resolution. I don’t want to put words into it, but, yeah, yeah, okay,

Derek Rinaldo 5:11

yeah. And, you know, I think there’s a lot of attention that may not be paid towards proper screening and preparation and the treatment or use of and then, you know, post experience integration that could really either just make it a whole lot more meaningful and generalized into their life experience, or to really help resolve, you know, some real adverse experience afterwards. So yeah.

Dr. Signi Goldman 5:47

And to be clear, these are people who have done psychedelic or with other providers, correct 10 or then coming to you almost as a corrective. 

Derek Rinaldo 6:00

Yes, you know, the because psychedelics have kind of gone mainstream, so to speak, you know. And I think, like you said, there’s a lot of enthusiasm, and there’s people who I think I hate to like, yeah, we just gotta be real here, unconscious incompetence. I’m going to call it, you know, who, like, I went to Peru, and I did this Ayahuasca thing, and I really made a big impact in my life. And I want to help people, fantastic. So then they come back, and maybe they did some little training here or there, but maybe not a lot of experience, and they, talk to somebody and say, Yes, I can be your healer. I can be your guide or facilitator. And then there’s, it’s not really managed properly and well enough, at least,

Dr. Signi Goldman 6:51

you know, yeah, I like that term unconscious incompetence. I would agree with that, because I think we all can appreciate that everyone out there doing this work, which is a rapidly growing amount of people now that ketamine assisted psychotherapy is really, you know, coming more into mainstream recognition, and there are more and more providers stepping into it, some of it trained by myself. So I’m aware this is an exponentially growing group of people. We can all sort of appreciate that everyone’s heart is in the right place, absolutely, for sure. But there also, I think, is a little bit of a naivete about what’s involved and what maybe you may be opening up right up into this work with someone. And so I’ve also witnessed the kinds of things that I think you have, and some you know, I am. I also feel very compelled to get that message out there. So it sounds like you, you know, and obviously, you know, you are also a psychedelic provider. So you also do this work. You’re not only working with people who are almost needing repair, you’re also working with clients that are that are coming to you to do the the original work. Yeah, it sounds like you’re referring to categories of harm which we can we can kind of talk about what the patterns are, you’re showing up. And then also people who like, as you referenced, are just like, put a lot of resources into getting this work done, and then it’s just not optimized in a way. It’s not useful, right? And there’s, I’m imagining a sense of, like, deflation or frustration, or like I failed at this, or this didn’t work for me. Or is that? Yeah,

Derek Rinaldo 8:28

that’s what I’m finding, too. And just to speak to some of the the main streaming I recently looked on Hulu and Netflix and prime and apple, and there’s a lot of shows about psychedelics. And I did a sort of a little random scan through a bunch of them, and overwhelmingly, very few of them touch upon harm, and most of them really idealize how fantastic it is and how healing and all of these things, and a lot of different traditions too. So I just, I hope people can be discerning as they’re getting information from mainstream places, podcasts or wherever, you know, and looking at, there are a couple podcasts about harm reduction with psychedelics, which are, which are good, yeah, you know. And festivals, for example, you know, there are harm reduction tents, like with Zen do project, or dance safe or something, you know. So harm is happening, adverse events are happening.

Dr. Signi Goldman 9:35

So, yes, and always have, you know, there’s been an underground world where this has been going as we know, psychedelic work, good, bad and in between has been going on for a long time, and those of us in the community have always known that it’s possible to cause harm with this. It’s just become, I don’t want to say, maybe, a challenging dialog in the public sphere right now. As we saw presented with even like the Lycos research going through the FDA process, where there seems to be sometimes, perhaps an accidental polarization in the public dialog, those that are like, this is going to save the world. This is the best thing ever. This is going to fix everything, and then for everybody, yeah, everybody, this is the solution for every Exactly, yeah. You know, there are some camps that are like, this is terrible and and which happen at all because they are very aware that harm has been done. And I think those of us who are in training programs or in conscientious practice, like yourself, there’s a we have to appreciate. There’s a both and and Yes. Only solution, and I’m speaking now from someone who trains therapists to do this, is to train people to understand that, yes, this powerful work, and also don’t be, um, overconfident, very, very cautious about dotting your eyes and crossing your T’s with all of the like safety pieces and so, yeah, so what are some of those safety pieces? There are some just universal things that you know, sort of ethical providers understand. Yeah. And I think, why don’t we just break it down into some sort of categories of things that you have seen go wrong? One that you and I have talked about is like inadequate screening, or people who really should be doing it at all. Can you, can you speak to what you’ve seen with that?

Derek Rinaldo 11:39

Well, one of the so there’s, there’s research that shows that people who have had prior bad trips, you know, intense fear and anxiety, and then they try it again, they’re more likely to have continued bad trips. So I’ve worked with a couple of folks who I said, yeah, when I was, when I was younger, I did these psychedelics, and it was really hard. I didn’t do it for a long time, and here I am trying it again and had a bad trip again. And so there, and there’s some research that shows you know like that, that can happen. And that’s not to say just because you did have a bad trip when you were 25 and now that you’re 40, that you will have a bad trip. That doesn’t mean but there, there is some tracking there,

Dr. Signi Goldman 12:31

maybe those people should be be approached differently, or Yes, exactly, particularly different precautions being put in place. Yeah. And

Derek Rinaldo 12:41

screen wise, there needs to be, you know, some look at just, you know, underlying conditions like schizophrenia or schizotypal tipple, sort of, you know, features intense, you know, fear and anxiety going into it. Family history of schizophrenia, bipolar, these are things that would probably get screened out in in many studies, they are there’s physical health, health risks to consider. You know, cardiac conditions, yeah, if there’s like seizure conditions that might be part of someone’s experience. And then, you know, other drug interactions, if someone’s on some other like serotonin drugs or Mao drugs inhibitors, those would probably need to be screened through,

Dr. Signi Goldman 13:36

yeah, especially depending on the medicine they’re going to be taking. Exactly,

Derek Rinaldo 13:43

and then, you know, there could be an increased risk of just poor judgment on the person who’s with medication in them. And you know, having there’s an increased risk of accidents or injuries that could happen if someone could get really behaviorally out of control. I’ve heard of people like sexually acting out, people getting aggressive.

Dr. Signi Goldman 14:11

So yeah, and are these are things that when people are coming in telling you that I’ve had this kind of aversive experience, these kinds of things that you’re being told they’ve experienced or witnessed. Or have you ever worked with someone who has had a prior bad trip, and I know you sort of put quotations around that when you said it and are coming in with fear and then successfully, then done medicine, work with them. Or do you discourage them from doing it. Where do you land with that?

Derek Rinaldo 14:46

I don’t, I wouldn’t, you know, discourage them, but I think it would need to be handled very, very carefully if going to do it. And you know, there’s some tropes out there, like, you know, the medicine only gives you. You need and at the time, or there’s no such thing as a bad trip. And, right? I don’t think those are really helpful

Dr. Signi Goldman 15:10

saying that to someone who is feeling trauma. Yeah,

Derek Rinaldo 15:13

exactly. So, yeah, I don’t discourage that, but I think those need to be really handled very carefully regarding the mindset going in the setting. Of course, the relationship with the sitter or the shaman or the facilitator or therapist, that’s a really important aspect of the experience in the setting.

Dr. Signi Goldman 15:39

Yeah, one thing I have found myself doing in those cases, in the ketamine clinic, because it is so ti tradable, is putting them on really low amounts, super, super low, and letting them have some sort of agency about when they go up or down, so that they can themselves. Like we have this conversation on, like we can lean into it a little. Now, you can pull back out. You can lean in. Now, a lot of these psych a lot of psychedelics, don’t have that kind of flexibility. But if you have an IV administration where you can literally dial it down or up, yeah, it’s sometimes as reparative for people to feel like, okay, I can, you know, I can collaboratively decide this with my therapist. I can back out at any moment, and I can use my own curiosity to explore it at my own pace and work with the fear that shows up there based on this prior traumatic experience. I had to kind of get into relationship with that and and I think you know, having witnessed that working for people, it just reinforces, to me how, you know, that’s not available in a lot of settings, but how just that person right back on a, what we would call, think of us like a full or regular psychedelic dose, and then it could be, you know, I don’t think that that would go well. So I can imagine that what you’re saying is correct. Yeah,

Derek Rinaldo 16:57

I often actually have encouraged somebody if they’re sometimes, people come to me and say, hey, I want to do this thing with somebody else that is going to do some kind of psychedelic thing. And I say, Well, if you’re going to do this, what you might want to do is try doing some breath work first, to have some kind of non ordinary State experience, you know, to see how that feels for them. Yeah, that’s they are going to go do something start low. You know, there’s some people who are just like, I want to hit the heroic dose and really get out there. And I call them bliss chasers, yeah, and so it’s interesting,

[Continue to Page 2]