Psychedelic-Assisted Therapy (PAT) And Occupational Therapy

Editor's note: This text-based course is a transcript of the webinar, Psychedelic-Assisted Therapy (PAT) and Occupational Therapy, presented by Gina Taylor, MS, OT, HPCS.

*Please also use the handout with this text course to supplement the material.

Learning Outcomes

After this course, participants will be able to:

• Recognize three primary legal concerns related to occupational therapy involvement in the emerging area of psychedelic-assisted therapy.
• Describe the basic phases of psychedelic-assisted therapy and where occupational therapy may contribute outside of medication administration.
• Identify the role of occupational therapy in assisting with the physical, sensory, and emotional set and setting in psychedelic-assisted therapy.

Introduction

I am excited to be here with you to talk about psychedelic-assisted therapy and the potential role for occupational therapy. Before we get into the content, I want to name something important about this topic: things are changing very, very quickly. The information I'm sharing with you is as accurate as I can make it for where we stand in 2026, but by the time you read this, some of it will likely have shifted. I want you to hold that lightly and always check the current legal and clinical landscape for your own state and scope of practice before you apply anything we talk about here.

This is really an introductory overview. My goal is to help you understand some key terms and considerations in a field that is emerging and growing quickly. It doesn't matter whether you think you might want to work in this space directly, whether you're coming from academia and want to be conversationally familiar with it, or whether you're a researcher considering new areas of inquiry. By the time we're through, I want you to have enough grounding to decide on your next step in learning.

The State of Therapeutic Psychedelics in 2026

The use of psychedelic medicine is a rapidly changing area, and I mean that literally week to week. On April 18 of this year, President Trump signed an executive order directing multiple federal agencies to expand research into and access to psychedelic treatments for serious mental health conditions. Several states already have psychedelic-assisted therapy programs in place. Colorado, Oregon, and New Mexico are operating programs, and New Jersey has an approved clinical research pilot program. On top of that, new legislation has come through in several other states just in the past week or so as I'm recording this.

There is a lot happening right now, but I also want us to recognize that psychedelic medicine is not new. It has been used within indigenous and cultural traditions for a very long time, and there are ongoing conversations in the field about what responsible, modern use of psychedelics should look like in relation to those traditions. We're not going to go deeply into that conversation today, but I want you to know it's an important part of this work.

What Is a Psychedelic?

Psychedelics are a class of psychoactive substances that cause non-ordinary or altered states of consciousness. They are often characterized by major shifts in cognition, sensation, and emotion — areas that occupational therapy providers are already quite familiar with in our work with clients. Classic psychedelics such as LSD, psilocybin, and DMT primarily act on serotonin receptors and can produce profound sensory experiences, including visual distortions and a heightened awareness of the environment. They may also produce mystical or spiritual experiences.

There are some substances that get grouped into this conversation without being classic psychedelics in the traditional sense. Ketamine is a dissociative. MDMA is best described as an entactogen or empathogen. Ibogaine is a psychoactive indole alkaloid. Each of these has a distinct pharmacological profile and experience, even though they are often discussed together in this emerging field. There is ongoing research into how psychedelics affect the body and cognition more broadly, but for our purposes today, I want to stay focused on their therapeutic use.

What Is Psychedelic-Assisted Therapy?

Psychedelic-assisted therapy is the therapeutic use of psychedelic substances combined with classic psychotherapy principles. It typically unfolds across several phases: screening, preparation sessions, the medicine session or sessions, and integration sessions. The overarching objective is for the psychedelic experience to help a person harness their "innate capacities to heal and grow" (Fahrenkopf, 2024).

Because psychedelic substances can also create challenging or difficult experiences, they must be used with care, and facilitators need to be trained to work with people moving through non-ordinary states of consciousness. As this field develops, I see many different roles taking shape — researchers, clinicians, and facilitators who support the medicine sessions. My particular interest, and the reason I wanted to talk with you today, is in exploring the potential roles for occupational therapy providers within this landscape.

Legality, Harm Reduction, and Other Liabilities

Before we talk about where occupational therapy fits into this picture, we need to be honest about legality and safeguarding, because that is where much of the risk lies for us as providers.

Legality and Safeguarding

Right now, all of these medicines are federally illegal except for ketamine. State and local reforms represent real progress, but they don't override federal law. That creates a legal mismatch: something might be legal at the state level while remaining illegal at the federal level. At the same time, many of our clients are seeking out or expressing interest in psychedelic medicines, which brings us squarely into the question of what our role is as therapy providers in supporting them.

Do we have an ethical duty to support our clients who are considering or already using psychedelics? And if so, what does that support actually look like? Incorporating psychedelics into a traditional occupational therapy setting carries real risk, both because of their prohibited status and because there is not yet a distinct standard of care in this practice area. That's why I think it's so important to have clear language ready for these conversations. I often frame it something like this with clients: please be aware that in most states, psychedelics remain illegal. I cannot procure any substances for you, nor can I act as your trip sitter or recommend a guide. That kind of disclaimer lets the client know exactly what role you are and are not playing if they choose to move forward.

With that foundation in place, there are three areas of legal exposure I want you to be aware of: criminal liability, malpractice, and action by licensing boards.

Legal Implications: Criminal

Psychedelic substances are still classified as Schedule I controlled substances under the Controlled Substances Act. The FDA regulates drugs, while state governments oversee the practice of medicine and therapy within each practitioner's scope. This puts psychedelic-assisted therapy in an unusual position: the substance is classified as a drug, but the therapy itself falls under the practice of medicine. You can see that split between what's happening at the federal level and what's happening at the state level running through nearly every aspect of this conversation. Federal crimes in this space could include things like racketeering, conspiracy to commit a crime, or aiding and abetting unlawful acts, including violations of drug house laws.

Legal Implications: Malpractice

Malpractice is a civil claim of professional negligence, and it generally requires four things to be present: the provider had a duty to the patient through the client relationship, the provider fell below an acceptable standard of care or created a dereliction of that duty, the provider's action or inaction led to damages, and that dereliction directly caused those damages.

When we apply that framework to psychedelics, a few scenarios come into focus. A therapist could be sued for failing to protect a client from harm, particularly if the client had a difficult experience. A claim could also be built on the argument that psychedelic-assisted therapy is a new treatment that lacks a robust evidence base within occupational therapy, specifically, or that the therapist departed from a more conventional, established approach to treatment without adequate justification.

Legal Implications: Licensing Boards

Of the three areas of risk, I think licensing board exposure is often the biggest. Even when we're not engaging in any behavior that violates the law, licensing boards have wide latitude to determine that a clinician acted outside their scope of practice. This is exactly where clear, unambiguous informed consent becomes so important — consent that spells out what psychedelic-assisted therapy is, what harm reduction strategies look like, and what role occupational therapy is actually playing.

Because this is such a novel and emerging area of practice, licensing boards may have limited familiarity with it, and there is still meaningful stigma around drug use in general. That means a licensing board could disapprove of a therapist's involvement even when that therapist is not explicitly providing psychedelic substances to clients. Licensing boards can receive complaints from clients, other clinicians, the general public, and family members, so there are many possible entry points for filing a complaint to be filed.

As of right now, neither AOTA nor individual state OT boards have issued formal guidance on psychedelic-assisted therapy, so there isn't much to point to yet. I will say there is growing interest — this year's AOTA National Conference included a presentation on psychedelic-assisted therapy, and I'm seeing interest surface at some state OT conferences as well.

Principles of Harm Reduction

This is an area where occupational therapy already has a good footing. Harm reduction approaches focus on the consequences of drug use rather than on eliminating drug use altogether. Instead of asking a client to stop using psychedelics entirely, a harm reduction approach works with the client toward their own goals and helps them evaluate whether their choices are moving them toward the life they want.

A few core principles anchor this work. We accept that illicit drug use is part of our world, and we choose to reduce harm rather than ignore or condemn it. We recognize that change is incremental — some ways of using drugs are safer than others, and drug use occurs along a continuum rather than as an all-or-nothing state. We prioritize quality of life as our measure of success rather than abstinence alone. And we offer non-judgmental, non-coercive care that respects a person's autonomy and choices, supporting harm reduction without imposing abstinence.

Beyond those foundational principles, harm reduction also asks us to recognize the value of lived experience — people who use drugs, or who have a history of drug use, have a real and valuable voice in shaping the programs and policies meant to serve them. It emphasizes autonomy, empowering people to be the primary agents of harm reduction for themselves and their peers. It calls for socio-cultural sensitivity, recognizing the many factors that shape a person's ability to manage or cope with drug-related harm. And it insists that we stay focused on harms — we do not minimize the very real harm that illicit drug use can cause.

What I find so useful about these principles is how closely they already align with the values we hold in occupational therapy. We already ask what is drawing a client toward a particular interest or behavior. We already support a client's power to make autonomous choices, with or without the use of psychedelics.

Harm Reduction for OT Providers

Let's bring this directly into our own practice, because I think it will feel familiar once we name it. With harm reduction, we are not waiting for someone to change their behavior before we help them. We do this constantly in occupational therapy already. We don't just tell someone not to walk alone if they're at risk of falling — we give them strategies and modify their environment. We don't tell someone with limited energy to simply rest more — we provide adaptive equipment. We don't tell a client with sensory sensitivities to just tolerate their environment — we give them strategies to become more aware of it and to shape it. The principles of harm reduction are already embedded in how we practice. What's new here is applying them specifically to psychedelic-assisted therapy.

The Role of OT in Harm Reduction for PAT

In this specific context, we can help a client assess their function in daily life before a medicine session and provide support as needed. We can work with providers to make sure spaces are safe for a client's needs and educate clients on the safety risks involved in psychedelic use. We can educate clients on their own sensory profile, self-regulation needs, and coping skills, and then help them think through how those intersect with a possible psychedelic experience. And we can offer harm reduction options such as breathwork, meditation, or other methods for reaching non-ordinary states of consciousness, particularly for clients who are drawn to that goal but haven't yet decided whether psychedelics are the right path for them.

More broadly, this might mean focusing on ADLs, sleep, nutrition, and routines, as well as nervous system regulation, so that a person feels safer and more grounded heading into a medicine session. It might mean helping reduce risk in daily life between sessions, especially as someone begins integrating changes they've noticed or want to put in place. It might mean helping plan for sensory supports, rest time, or lower-demand periods surrounding a medicine session. And it might mean helping a person make sense of the changes in their body, offering real, hands-on, movement-based activities that help them feel more settled and grounded, and then helping translate that felt sense into their daily experience moving forward. At its core, our role in harm reduction is helping a person understand why they're choosing this path and how we can support them along it.

Team Roles in Psychedelic-Assisted Therapy

Psychedelic work draws its language from medicine, psychology, and community traditions all at once, so you'll encounter a variety of titles for team members. A medicine provider or prescriber is the person legally permitted to prescribe the psychedelic substance, which varies by state and by substance. A facilitator is trained to support a participant during the medicine session itself. A therapist provides the preparation and integration sessions. A sitter is a layperson who remains sober throughout someone else's psychedelic experience. A trip check is a peer support service that can be called and offer a stable point of reference during the experience.

Psychedelic-assisted therapy is rarely delivered by a single professional. It is typically provided through a team model that may include psychiatrists or prescribing physicians, psychologists, licensed therapists such as LCSWs, LPCs, or LMFTs, nurses and other medical staff for monitoring, facilitators or guides depending on the program, and integration therapists or counselors. Occupational therapists are part of this broader interdisciplinary picture, and I think our understanding of supporting daily function and helping people make sense of new experiences is part of why our profession is beginning to show real interest here.

Pulling It Together

There's an image I keep coming back to when I think about this field — a game of Jenga, where every decision rests on the pieces underneath it. Psychedelic-assisted therapy is a field that is still very much taking shape, and training, supervision, legal awareness, and ethical considerations all matter enormously right now. In some ways, the legality piece feels like the bottom block in that tower, and as it shifts, the whole foundation shifts with it.

As occupational therapists consider stepping into this space, we need to stay grounded in our own scope of practice and carefully consider which education would support us and where we want to collaborate with other professionals. If occupational therapy is going to enter this space well, we need to bring our expertise and share it with the broader team, because there are real gaps here that our profession is well-positioned to address.

I want to invite you to take a moment to reflect on your comfort level with all of this. Some of you will feel ready to explore new areas very early. Others will prefer to wait until more established systems and standards are in place. Some of you may be interested purely from a research or academic angle. Others might want to move toward preparation and integration work, potentially even becoming a state-licensed facilitator. And some of you will decide this isn't the right fit for your practice right now. All of those responses are valid. What matters most is answering that question honestly for yourself.

The Role of OT in Set and Setting

Now that we've walked through some of the legal terrain, let's shift toward what occupational therapy can actually contribute. This is where I think our contribution becomes very clear, very quickly.

What Is Set and Setting?

Set and setting are concepts that come up constantly in psychedelic work, and they strongly influence how a person receives the medicine. Occupational therapists are already skilled at looking at the relationship between the person, the activity, and the environment, so the Person-Environment-Occupation (PEO) frame of reference translates very naturally into thinking about psychedelic-assisted therapy.

A set is broadly defined as a person's mindset going into the altered state of consciousness. It includes mood, feelings, expectations, goals, openness to the experience, and mental preparation. Anxiety or unresolved worries can increase the potential for an adverse experience. Mindset isn't just a person's attitude in the moment — it's the full internal state someone brings with them, shaped by the history of trauma, felt sense of safety, and readiness for change.

The setting is the external environment. It includes social aspects, temperature, space demands, and sensory aspects such as sounds, smells, and textures. I want you to consider something with me for a moment: you wouldn't expect that taking antibiotics in my parents' kitchen would work any differently than taking the same antibiotics in my neighbor's living room, and you wouldn't expect the antibiotics to behave differently based on whether I was happy, sad, or anxious. Psychedelics are undeniably different. The physical environment has a real, measurable impact on a person's experience.

This isn't a new discovery. Early psychedelic researcher Al Hubbard recognized that the clinical spaces where early research was taking place were shaping the entire experience, and he created a space, known as the Hubbard Room, decorated to feel more like a home in response. This has always been an important consideration within indigenous cultures, and their use of psychedelics as well, and the current medical model would do well to keep learning from those practices, which support a more holistic experience for the client.

Who Helps Shape the Setting?

In many programs, mental health clinicians focus on psychological support, medical staff monitor safety, and other professionals maintain the physical environment. Occupational therapy skills complement all of these roles by specifically addressing safety, comfort, and environmental factors. A facilitator supports the experience itself; a medical provider monitors safety; support staff assists with the environment; and OT contributes sensory and environmental considerations that tie it all together.

Physical Aspects of Setting

Some of the physical aspects we consider are designed specifically to support comfort and safety: soft lighting, a quiet space, and items that help a client's body feel supported and able to relax. The journey itself is meant to be an internal one, and while psychedelics heighten sensory perception — especially to light, sound, and touch — in ways that can feel more intense than usual, we want the environment to feel calm and predictable so the client can stay present with what's unfolding and move inward with it.

From an OT lens, we're already considering the environment in great detail. We think about space demands and how they affect interaction, lighting, noise, physical comfort, social context, and even technology, all of which shape the experience and the client's longer-term occupational performance. These factors help determine whether the environment feels supportive, whether the client feels safe, and how fully they're able to participate in the medicine session itself.

OT's Specialized Knowledge in Set and Setting

The setting is the context for the psychedelic experience, and occupational therapists are well-positioned to help guide how it's structured. We already consider a client's internal state, their sensory profile, and the personal goals they've shared with us, and we can make sure the environment supports all of that. This is a natural extension of work we're already doing — using our specialized knowledge of a client's sensory map and long-term goals to prepare a setting that genuinely supports them.

I'd encourage you to take a moment to think about which aspects of the sensory setting might be important for a given client to explore — things like sensory comfort, predictability, and what helps that client feel secure in a space. Decreasing clutter, having a safe place to sit or lie down, removing distractions, creating a calm and open space, offering something like a weighted blanket or an eye mask, and deciding in advance whether touch will be part of the experience are all considerations that come up again and again. Temperature matters too — think about how hard it can be to settle into a yoga class if the room is too cold. All of these reflections on set and setting are really laying the groundwork for the preparation and integration work that follows.

The Role of OT in Preparation and Integration

This is where occupational therapy practitioners can actively guide a client through the entire experience.

I want to offer you a simplified timeline of the psychedelic-assisted therapy experience. It begins with screening, during which we gather history, assess the client's goals, and determine readiness. Screening is not about screening people in—in fact, a well-run screening process actively screens people out where appropriate. That step comes before preparation sessions, which focus on mindset, environment, readiness for change, and whether safety plans are in place. Next comes the medicine session itself, which is the acute psychedelic experience. Occupational therapy providers are often not part of this stage unless they are also a licensed facilitator — that would be a different hat entirely. In many cases, OT is more active in the stages before and after the medicine session, working alongside other providers who are more present during screening and the session itself. Then comes integration, and this is often where occupational therapy can really shine, because we're able to help translate the insights a client had during their medicine session into lasting, meaningful change.

What Does Preparation Mean?

Preparation is the process in which a client explores the risks and benefits of using a psychedelic substance, receives harm reduction education, explores alternatives, learns about the effects of the substance, chooses possible goals or intentions, and creates a plan with safeguards in place.

Part of preparation involves building what I'd call psychedelic safeguarding plans — practical strategies for the session itself. That might include ensuring other responsibilities are covered in advance. If a client is engaging with the medicine at home, do they have a safety plan? Have they documented the substance and the timing of its use? If they're in a clinical setting, preparation might focus more on identifying triggers, having grounding tools ready, establishing a communication plan, and deciding in advance how the client wants a facilitator to respond if they become overwhelmed. Clients using the medicine outside a clinical setting might choose to arrange a trip check — a service that calls to check in and offer support during the experience.

Preparation can look very different depending on the setting. In a retreat model, it's often a single day held before the medicine session, sometimes as short as a few hours. In other models, especially when someone is working toward more significant life changes, preparation might unfold over several weekly sessions.

The Role of OT in the Preparation Phase

Occupational therapy practitioners can assist clients throughout this phase in several concrete ways. Preparation may involve collaboration with a therapist or psychologist providing psychological preparation, a physician overseeing the medication protocol, and program staff coordinating logistics, and OT contributes by supporting routines, expectations, and regulation strategies.

Since preparation is everything that happens before the medicine session itself, our contribution includes building trust, helping set intentions, clarifying expectations, and planning support for the session. We bring our knowledge of a client's sensory profile, help them think through an environment that will support them, and help them decide whether touch will be part of the experience and how that choice might enhance or detract from their comfort and internal focus. This is also where harm reduction strategies come into play — identifying potential challenges, safety measures, and ways to move through more intense moments within the experience. Good preparation increases the likelihood that a client will get meaningful insight from the medicine session and will be able to make use of that insight afterward.

One of the most valuable things we offer here is helping a client understand their own sensory profile — how they respond to touch, sight, sound, and movement — which can give them real insight into their preferred regulation strategies. This kind of proactive planning supports comfort and emotional regulation throughout the entire arc of the experience, not just in the moment of preparation.

The Medicine Session

The duration of the medicine session varies quite a bit by substance: typically a few hours for ketamine, six to eight hours for psilocybin, around twelve hours for LSD, and up to thirty-six hours for ibogaine. Usually, two facilitators are present. A client may listen to curated music and wear eye shades to focus more fully on their internal experience. Facilitators are trained to take a non-directive approach — the client should be able to move through the experience without outside influence — while still being available to support the client if they encounter fear, confusion, uncomfortable body sensations, or difficult moments of attachment. The facilitator's role is to monitor safety and address comfort needs such as hydration or restroom access.

What Is Integration?

Integration is the phase in which a client makes sense of the insights, experiences, and sensations encountered during the medicine session. It is an ongoing, non-linear process —it doesn't happen all at once or in a predictable order.

The Role of OT in Integration

Integration may involve multiple disciplines: a psychotherapist guiding meaning-making, peer support or integration groups, case managers, and OT supporting daily routines, habits, and participation. This is where occupational therapy practitioners bring a genuinely unique perspective, one grounded in activities of daily living and routines. While a therapist is often focused on emotional processing, we focus on helping a client translate their experience into daily life, new habits, and meaningful participation.

In practice, that might look like helping a client with an activity analysis, reviewing a time tracker together, looking at whether their current routines align with their stated values, adjusting their environment, and working on self-regulation strategies. The throughline is always helping a client carry the insights from their medicine session into their everyday occupations. It's important to remember that this doesn't happen in a straight line — insight or discomfort may not surface immediately after the experience; it can surface later, and we need to be ready to support a client through it whenever it emerges. Our focus stays on functional change: adjusting the environment as needed and helping the client feel aligned with the goals they've chosen for themselves.

Ethics, Scope, and Next Steps

As we move into our final section, I want us to focus on professional practice and practical next steps, because this is especially important in an area that's still being defined. My hope is that each of you leaves today equipped to move forward safely, thoughtfully, and responsibly, grounded in occupation and participation while bringing your own unique lens to this work.

Ethics in Psychedelic-Assisted Therapy

I think it's especially important to talk about the MAPS Code of Ethics here. MAPS stands for the Multidisciplinary Association for Psychedelic Studies, a 501(c)(3) nonprofit that many professionals look to for both guidance and research. Its code of ethics for psychedelic psychotherapy covers twelve areas: safety; confidentiality and privacy; transparency; therapeutic alliance and trust; use of touch; sexual boundaries; diversity; special considerations for non-ordinary states of consciousness; finances; competence; relationship to colleagues and the profession; and relationship to self.

One issue worth naming directly is cost. Psychedelic medicine sessions are currently largely paid out of pocket, often running around $2,000, and when insurance doesn't cover that cost, it becomes inaccessible to people of lower socioeconomic status. This raises real concerns about barriers for marginalized populations who might otherwise benefit from this treatment. New Mexico has responded by setting aside over $630,000 to create a medical psilocybin equity fund and a psychedelic access equity fund, aimed directly at making treatment more affordable for low-income and rural residents. As we think about ethical practice more broadly, we also need to expand the boundaries of our own competence — obtaining adequate training and seeking consultation from other professionals. There are a number of training programs focused on psychedelic-assisted therapy, but there isn't yet a consensus on minimum training standards, so this is an area where you'll need to do some of your own due diligence.

OT-Specific Ethical Considerations

There are a few areas of ethics that I think are particularly relevant to our profession. Occupational therapists may not have much training in non-ordinary states of consciousness, and that gap can affect how we interpret a client's experience and how we respond in moments of vulnerability. Clients may be more open to suggestions — not just during the medicine session itself, but also afterward, during integration. That makes it essential that we hold very clear boundaries, understand consent thoroughly, and stay aware of the safety barriers that need to be in place around this work. We need to remain aware of power dynamics and avoid unintentionally influencing a client's experience, which means ongoing learning, supervision, and professional mentorship are essential to practicing safely and ethically in this space.

It may also be difficult, at least initially, to find other OT colleagues working in this area. The MAPS ethical guidelines speak directly to this need for consultation: "To maintain the highest integrity in our practice, we consult with fellow practitioners and colleagues. We commit to asking for feedback and being open to receiving it, as well as offering feedback when it may be needed" (MAPS, 2021). I'd add to that: therapists working in this space should commit to a practice of self-compassion and self-inquiry, out of respect for the transformative power of the experiences we're supporting our clients through.

The Potential Scope of OT, Now and in the Future

Right now, our involvement should stay closely aligned with our existing scope of practice. That includes preparation work, a focus on sensory supports, attention to ADLs, and helping clients integrate their insights into daily routines — areas where we're already well versed and where this work fits naturally. As the field grows, I expect we'll see more opportunities for occupational therapy in both research and clinical roles. Researchers are exploring not only the psychological dimensions of psychedelics, but also whether there might be applications for motor rehabilitation, given that psychedelics appear to open a critical window for neuroplastic change. That's an area occupational therapy providers may find themselves stepping into as the evidence base matures.

Looking ahead, I'd describe the future scope of OT in psychedelic-assisted therapy in two parts. Right now, our role is to provide harm reduction education during preparation and integration for a client who has already chosen to engage with a psychedelic substance. In the future, I anticipate OT participating within full interdisciplinary teams, working within our scope to provide holistic preparation for medicine sessions, supporting medicine providers in creating contexts for safe and meaningful sessions, and staying engaged with clients throughout integration to help ensure that change is lasting and transformative in their daily lives.

Next Steps for OT Practitioners

As you consider your next steps, I'd encourage you to base them on your comfort level. Learning more about harm reduction is a strong starting point for almost any clinician, regardless of how deeply you want to go into this space. From there, psychedelic-assisted therapy-specific education can deepen your understanding of the roles within this field, the different substances involved, and the specific laws around state facilitation — these programs are substantial, often spanning nine to twelve months of study. Because this field is still developing, I'd also encourage you to seek out mentoring from other occupational therapy practitioners who are already working in psychiatric and psychedelic-assisted therapy settings. We're going to need that kind of continued peer support to really understand our unique role here as it continues to take shape.

Before we close, I want you to sit with the range of concepts we've covered today and ask yourself honestly: is there one step that feels realistic or appropriate for you right now? There's no wrong answer to that question, whether it's continuing to learn, seeking out harm reduction training, or deciding this isn't the right area for your practice at this time.

Conclusion

Psychedelic-assisted therapy is a genuinely emerging area of practice, and I hope this course has given you a grounded, honest picture of both the opportunity and the risk involved for occupational therapy. We started by looking at legality and safeguarding, and I hope you leave with a clear sense of the three primary areas of legal exposure that matter most here: criminal liability tied to the Schedule I status of these substances, malpractice risk in a field that doesn't yet have an established standard of care, and licensing board exposure, which may be the greatest risk of all given how little formal guidance currently exists.

We also walked through the basic phases of psychedelic-assisted therapy — screening, preparation, the medicine session, and integration — and I hope it's clear that occupational therapy's most natural and well-supported contributions sit in preparation and integration, rather than in the medicine session itself, unless you also hold a separate credential as a licensed facilitator. Our profession's strengths in sensory processing, routines, habits, and daily function translate directly into this work, even though the substance itself remains outside our scope.

And finally, we spent real time on set and setting, because I believe this is where occupational therapy's contribution is clearest and most immediately useful. Our understanding of the relationship between person, environment, and occupation gives us a natural lens for helping shape the physical, sensory, and emotional context that supports a safe and meaningful experience for a client, whether that's attention to lighting and temperature, decisions about touch, or simply helping a client feel secure enough in a space to move inward.

This is a field that will keep evolving, sometimes week to week. My hope is that you leave this course with enough grounding to know where you stand, whether that's continuing to learn, pursuing further training in harm reduction or specifically in psychedelic-assisted therapy, or simply staying informed as an occupational therapy practitioner watching this space develop. Wherever you land, I'm glad you took this time to think it through with me.

References

See additional handout.