Your client is microdosing. Now what?

Hey there,

Has a client ever told you they're microdosing?

Or that they're planning a psilocybin retreat, or starting ketamine treatment?

Psychedelic use is coming up a lot more often during sessions, leaving many EMDR therapists unsure of their role. We're not prescribing or providing these substances, but clients are using them anyway and bringing those experiences back into our offices.

That’s why this week, I wanted to look at what the research says about macro-doses and micro-doses, and what that means for EMDR therapists who want to support clients before and after they pursue psychedelic treatment on their own.

A quick note before we start: none of this is a recommendation to use psychedelics, and nothing here should be taken as dosing guidance. My focus is on the clinical side: what we can do (as therapists) before and after a client's psychedelic experience.

What the Research Says About Macro-Doses

Most clinical research on psychedelics has looked at what's often called macro-dosing. That means one or a few high doses taken in a supervised setting, with preparation sessions beforehand and integration sessions afterward.

The strongest recent data for classic psychedelics comes from psilocybin in treatment-resistant depression, where Phase 2 and ongoing Phase 3 trials (such as Compass Pathways' COMP360 program) have shown significant reductions in depressive symptoms. For many responders, the benefits lasted months.

MDMA-assisted therapy for PTSD has also shown significant results in two Phase 3 trials, but the FDA declined to approve it in August 2024 and asked for more research, so it remains unapproved in the US.

Ketamine is a different case.

Ketamine is a legal, prescribed medication, and an esketamine nasal spray has been FDA-approved for treatment-resistant depression since 2019. Ketamine-assisted psychotherapy is also offered off-label in many clinics.

So where does that leave us?

While participants in clinical trials get structured preparation and integration therapy before and after their psychedelic experiences, clients who pursue psychedelics on their own rarely do, and that’s where we can help.

What the Research Says About Micro-Doses

Microdosing means taking a small amount of a psychedelic (below the level that produces obvious perceptual effects) often on a regular schedule. It's popular, and many people who microdose will tell you it helps their mood or anxiety.

The controlled research is less encouraging.

When studies have used placebo controls, they've mostly failed to find benefits beyond placebo. A later reanalysis suggested the differences people reported could largely be explained by expectancy, partly because participants could often guess which capsule they'd taken. Another study found that people's positive expectations before they started predicted how much better they felt afterward.

Of course, that doesn't prove microdosing does nothing. The evidence so far just doesn't support many of the claims clients may have read online.

For EMDR therapists like you or me, this is important because these expectations are clinical material. A client who believes microdosing is doing the healing may credit the substance for progress that came from their own work, or feel like a failure when it doesn't help.

So how do we support clients who are going to use psychedelics either way? One framework I find helpful is PHRI.

Meeting Clients Where They Are

Psychedelic Harm Reduction and Integration (PHRI) is a framework published in 2021 by Ingmar Gorman, Elizabeth Nielson, and colleagues. PHRI is designed for working with clients who are using or considering using psychedelics in any context, without the therapist ever providing the substance. It draws on harm reduction psychotherapy, which meets clients where they are without requiring abstinence, and asks the therapist to approach a client's choice with curiosity first and foremost.

PHRI pairs well with EMDR because so much of it happens in places we already work: assessment, preparation, and processing.

Before a Client's Psychedelic Experience

When a client tells you they're planning a psychedelic experience, the AIP model gives you a useful way to think about it. A high-dose experience can activate memory networks the client hasn't processed yet, sometimes ones they didn't know were there.

That makes preparation especially valuable.

Phase 1 history-taking can help you and the client anticipate what material might surface. Phase 2 resourcing, including calm place, container, and grounding skills, gives the client tools to use if things get hard. Some clinicians also choose to process key target memories beforehand, to reduce the chance of overwhelming material coming up unexpectedly.

The preparation phase is also a good time to ask some important questions.

What is the client hoping for? Are those expectations realistic given the research? Have they talked with a prescriber about the medications they take?

Some combinations carry known risks (lithium with classic psychedelics, for example, has been associated with seizures), so a prescriber needs to be part of that conversation too. Is there anything in their history, such as psychosis or bipolar disorder, that could make an intense experience riskier?

After the Experience

EMDR has a lot to offer during integration.

Clients sometimes come back with insights they want to hold onto, and sometimes with difficult experiences they can't make sense of, which can become a target in its own right. A frightening moment during a journey, a memory that surfaced unexpectedly, or a lingering body sensation can all be processed with the standard protocol once the client is stable.

For positive insights, resource development and installation or a future template can help the client carry what they learned into everyday life.

It's also worth watching for destabilization.

Some clients feel shaken for days or weeks after a difficult experience, and when that happens, it’s important that stabilization comes before processing. If symptoms suggest something more serious, bringing in a psychiatrist or other medical provider might even be necessary.

A Note on Ketamine and Ongoing Microdosing

Macro-dose experiences with psilocybin or MDMA tend to be one-off events. Ketamine treatment and microdosing are different, because they might happen on an ongoing basis, right alongside your regular sessions.

Ketamine is a dissociative agent, which raises some important questions for EMDR, especially with clients who already have dissociative features. We don't yet have good research on how ketamine treatment and EMDR sessions interact, so coordinating with the prescriber is generally the safest approach for now.

We also don't have research on how regular microdosing affects EMDR processing. The practical approach, in my experience, is to ask about it and track it alongside SUDs and VoC.

Staying Within Your Scope

PHRI asks a lot of us ethically.

Supporting a client who has chosen to use psychedelics is very different from encouraging use, telling them where to find substances, or advising on doses, and we need to stay clearly on the right side of that line. Always review your licensing board's guidance, document your harm reduction stance and informed consent conversations, and confirm your liability coverage beforehand.

(Pilecki, Luoma, and colleagues published a helpful 2021 paper on the ethical and legal issues of supporting clients who use psychedelics if you want to go deeper into it.)

This is also an area where consultation makes a huge difference.

If more of your clients are bringing psychedelic experiences into the room, it helps to have a consultant or colleagues who work in this space and can help you think through the gray areas.

That's part of why Helicon's consultant directory shows each consultant's specialties, so you can find someone with experience in the areas you're running into.

Are you seeing more clients bring up psychedelics or ketamine?

Hit reply and tell me how you're handling it.

Also, checkout the further reading and CEU opportunities on this topic below. And if you'd like to connect with other EMDR therapists working through the same questions, you can join the Helicon notification list here.

Until next time,
Chris

Previous EMDR Therapist Weekly articles on this topic:

EMDRIA OnDemand trainings on this topic:

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