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TEMENOS

Code of Ethics

 

Temenos is committed to providing ethical, quality, and comprehensive psychedelic-assisted psychotherapy services to people in our community who are coping with mental health issues.

 

We currently offer psychedelic-assisted psychotherapy only with the off-label use of ketamine; and we look forward to becoming an Expanded Access Clinic for MDMA in early 2020. We do not endorse, condone, or use illegal substances of any kind. 

 

We take seriously our obligation to provide safety to our clients; and we are committed to our own ongoing training and supervision in providing our services. 

 

Our Code of Ethics is based in large part on one recently written by MAPS (Multi-Disciplinary Association for Psychedelic Studies), along with the collective wisdom of several other organizations and individuals in the psychedelic and psychotherapeutic fields, including: the Council on Spiritual Practices, the American Psychological Association, and The Ethics of Caring: Honoring the Web of Life in Our Professional Healing Relationships by Kylea Taylor, M.S., LMFT.

 

Preamble

 

For the purpose of protecting the safety and welfare of our clients, this Code of Ethics outlines ethical principles governing treatment decisions made by our clinicians administering psychedelic-assisted psychotherapy within our clinic. 

 

As clinicians, it is our individual and collective responsibility to aspire to the highest standards of integrity and ethical conduct. We agree to practice psychedelic-assisted psychotherapy within our scope of competence and in accordance with this Code of Ethics. We directly address concerns regarding ethical issues and use clinical judgment, supervision, and consultation when ethical dilemmas arise.

 

The practice of psychedelic-assisted psychotherapy aims to provide an environment of safety and support for a person to engage with their own inner healing intelligence, one’s innate wisdom and ability to move towards wholeness and well being.  We act in the spirit of service to support each client’s connection to their own inner healing intelligence. We devote ourselves to establishing therapeutic relationships based on trust, care, and attunement, and to support our client’s own unfolding experience.

 

This modality involves deep work with trauma and attachment, as well as non-ordinary states of consciousness; therefore, psychedelic-assisted psychotherapy carries unique ethical considerations. These considerations include the potential for greater client suggestibility, the particular need for sensitivity regarding consent, and the likelihood of stronger and more complex transference and countertransference. Given the special considerations of this modality, we take seriously our obligation to client safety. This work requires an elevated quality of presence, tending to the process consistently throughout long psychedelic-assisted psychotherapy sessions, as well as during the phases of preparation and integration.

 

In order to provide impeccable care and to evolve ethically, we engage in practices of self-care, self-growth, and self-examination, aligning with our own inner healing intelligence. We give and receive feedback from mentors and colleagues, and participate in continuing education.

 

This modality is founded on the practices of healers, explorers, researchers, and indigenous traditions which stretch back centuries. We honor these contributions and recognize the privilege of working with non-ordinary states of consciousness. The ability to participate in these healing practices, as ancient as they are innovative, is both a gift and a responsibility.

 

Ultimately, we envision a world where all people can access healing. We view our clients’ challenges, as well as their growth, within a greater web of relationships, acknowledging that trauma, as well as healing, is passed between people, across cultures, and through generations. We aim to validate and support the intrinsic wisdom and healing intelligence in others as well as in ourselves, in service to collective healing, liberation, and greater engagement in the fullness of life.

1. Safety

 

We commit to the safety of our clients.

 

We ensure that a person is an eligible candidate for treatment both medically and psychologically, prior to the administration of any medicine. An eligible candidate has the resources necessary to engage in treatment, ideally including supportive people in their life and a stable and safe living environment.

 

We conduct thorough and comprehensive preliminary screening and preparation.

 

Prior to initiating treatment, we provide clients with clear information about our availability, backup support, and emergency contacts.

 

We take measures to prevent physical and psychological harm. We ask clients not to leave during medicine sessions. We inform clients that we will take precautions to ensure their safety, such as preventing falls or injuries.

 

We immediately address medical emergencies.

 

We have a crisis plan prepared, where a qualified professional is available in the event of client crisis or medical complications. We maintain responsibility for addressing crises as long as the client is under our professional care.

 

We provide thorough post-session integration with clients. 

 

We never abandon a client. We conduct appropriate termination, with preparation when possible, and provide referrals to other providers.

 

We adhere to laws and guidelines regarding storage and security of psychedelic medicines.

 

2. Confidentiality and Privacy

 

We commit to the privacy of our clients and uphold professional standards of confidentiality.

We adhere to applicable patient privacy laws and regulations, such as the HIPAA Act, and other local, State, and Federal statutes.

 

We discuss the limitations of confidentiality with our clients during the informed consent process and before initiating treatment. Depending on the licensing agency and the law, exceptions to confidentiality may include mandated reporting if there is reason to believe that a child, elderly person, or dependent adult is being abused or has been abused, if there is a serious threat to harm an identifiable victim, including oneself or another, and when required by a court order. Under these conditions, we release the minimum amount of client information required.

 

We may occasionally discuss cases as part of professional consultation and supervision, in which our consultants and supervisors are also obligated to respect client privacy, and we will provide the minimum amount of identifying information.

 

Outside of these limitations in confidentiality, we never release personal information about clients without their explicit permission.

 

We make agreements with our clients about acceptable and preferred means of communication, such as leaving voicemails, sending text messages, hours of contact, and response time.

 

We securely store treatment records and session recordings.  We promptly respond to breaches in confidentiality.

 

We seek legal counsel as needed to maintain clients confidentiality.

 

3. Transparency

 

We respect clients’ autonomy and informed choice.

 

We include our clients in treatment decisions. 

 

We obtain informed consent before conducting treatment and when introducing a new intervention or technique. We honor the client’s option to withhold or withdraw consent at any time.

 

We inform clients of all treatment procedures, including an accurate description of medicines used, potential risks and benefits, as well as alternative treatment options.

 

We discuss the process of termination with our clients at intake.

 

We inform clients if we have significant reason to believe they may not be benefitting from treatment.

 

We accurately represent our background and training using appropriate terms according to applicable laws and professional code.

 

In advance of treatment, we inform clients of our fees and the process for collecting payment.

 

We obtain consent to record sessions when applicable and to use recordings solely for purposes explicitly agreed upon by the client, such as for training and supervision, or for the client’s personal use.

We obtain informed consent for any physical touch by describing the type of therapeutic touch. Physical touch is never sexual and we make agreements about how the client can stop touch at any time.

 

We inform clients in advance about the possible or scheduled presence of assistants or any other staff who may be a part of treatment and/or have access to patient-identifying information.

 

We provide consistent care to our clients and arrange backup and emergency contact when we are unavailable.

 

4. Therapeutic Alliance and Trust

 

We act in accordance with the trust placed in us by clients.

 

We aspire to create and maintain therapeutic alliances built on trust, safety, and clear agreements, so that clients can openly engage in inner explorations.

 

We respect the inner healing intelligence of our clients to guide their experience.

 

We understand that the healing process is deeply personal; each client has different needs for support.

 

We set our clients’ best interest above our own interests, within the bounds of our therapeutic relationship.

 

We treat people receiving services or reaching out for services with respect and compassion.

 

We acknowledge the inherent power differential between clinicians and clients, and we act conscientiously in the service of clients’ self-empowerment.

 

We avoid entering into dual relationships that are likely to lead to impaired professional judgment or exploitation. In cases where there is a dual relationship, we give special attention to issues of confidentiality, trust, communication, and boundaries, and seek supervision as needed.

 

We use careful judgment about any continuing interaction with existing or previous clients outside of treatment.

 

When treating couples or families, we always consider potential conflicts of interest, disclose policies on communicating information between family members, and discuss continued care and treatment plan.

 

5. Use of Touch

 

When using touch as part of our practice, we commit to obtaining consent and offering touch only for therapeutic purposes.

 

We only offer techniques, such as touch, if they fall within our scope of practice and competence.

When touch is part of our practice, we discuss consent for touch during intake, detailing the purpose of therapeutic touch, how and when touch might be used and where on the body, the potential risks and benefits of therapeutic touch, and that there will be no sexual touch.

 

We obtain consent for touch prior to the client ingesting medicine, as well as in the therapeutic moment. Aside from protecting a person’s body from imminent harm, such as catching them from falling, the use of touch is always optional, according to the consent of the client.

 

We discuss in advance simple and specific words and gestures the client is willing to use to communicate about touch during therapy sessions. For example, clients may use the word “stop,” or a hand gesture indicating stop, and touch will stop.

 

We practice discernment with touch, using clinical judgment and assessing our own motivation when considering if touching a client is appropriate.

 

6. Sexual Boundaries

 

We do not initiate, respond to, or allow any sexual touch with clients.

 

While we respect the sexual identities and expression of our clients, and validate clients’ processes that might relate to sexuality and sexual healing, we firmly maintain the responsibility as providers of upholding clear professional boundaries.

 

We do not engage in sexual intercourse, sexual contact, or sexual intimacy of any kind with a client, or a client’s spouse or partner, or immediate family member, during or after the termination of the therapeutic relationship. While we believe this guideline applies indefinitely to former clients, in the rare case in which a clinician and client might consider engaging in such activities, there must be a period of two years since last professional contact, and the clinician is responsible for assuring that there has been no exploitation in light of factors including: time passed since termination, the nature, duration, and intensity of the therapy, the circumstances of termination, the client’s personal history and current mental and emotional health, and the likelihood of harm to the client. If a clinician has a licensure board with more restrictive regulations, these regulations take precedence.

 

We commit to examining our own erotic and sexual countertransference, to not act in ways that create ambiguity or confusion about erotic and sexual boundaries, and to seek supervision as needed.

 

As representatives of this work, we aim to uphold clear sexual boundaries and ethics in our daily lives.

 

7. Diversity

 

We respect the value of diversity, as it is expressed in the various identities and experiences of our clients.

 

We do not condone or knowingly engage in discrimination. We do not refuse professional service to anyone on the basis of race, gender, gender identity, gender expression, religion, national origin, age, sexual orientation, or socioeconomic status.

 

We take steps to examine unconscious biases that we may hold and commit to ongoing self-reflection to unlearn oppressive patterns.

 

We make every effort to include people living with physical, mental, and cognitive disabilities.

 

We respect the unique experiences of our clients, and practice openness towards different peoples’ values, belief systems, and ways of healing.

 

We are attentive to the impact of power dynamics in our relationships with clients, particularly where there are differences in privilege, gender, race, age, culture, education, and/or socioeconomic status.

 

We strive to be honest with ourselves and with our clients about the limits of our understanding, and to hold genuine curiosity and interest as we relate to our clients’ experiences.

 

We aim to provide culturally-informed care, and seek education in support of greater cultural understanding. We refer clients to other providers as appropriate.

8. Special Considerations for Non-Ordinary States of Consciousness

 

We tend to special considerations when working therapeutically with clients in non-ordinary states of consciousness.

 

Clients in non-ordinary states of consciousness may be especially open to suggestion, manipulation, and exploitation; therefore, we acknowledge the need for increased attention to safety and issues of consent.

 

We examine our own actions and do not engage in coercive behavior.

 

In working with non-ordinary states that can evoke unconscious material for both the clients and the clinician, we acknowledge the potential for stronger, more subtle, and more complicated transference and countertransference, and with that in mind, we practice self-awareness and self-examination, and seek supervision as needed.

 

We respect the spiritual autonomy of our clients. We practice vigilance in not letting our own attitudes or beliefs discount or pathologize our clients’ unique experiences. We hold and cultivate an expanded paradigm, which includes the experiences people have in extraordinary states.

 

We protect our clients’ health and safety through careful preparation and orientation to the therapy process as well as to thorough integration.

 

We support clients who may experience a crisis or spiritual emergency related to psychedelic experiences with appropriate medical and psychological care, engaging the support of outside resources as needed.

 

9. Finances

 

We maintain clear communication with clients about fees, and we aspire to increase financial access to services. We disclose our fees and payment procedures before enrolling a client in treatment.

 

We advocate for our clients with third party payers, including health insurance reimbursement, sponsors, and donors when appropriate. We provide Billing Statements to our clients so they are able to submit them to their insurance providers. 

 

We create opportunities for clients who are unable to afford the full cost up-front to engage in treatment, by considering income-based fees, sliding scale, pro-bono work, scholarship, sponsorship, and donor-supported services.

 

We do not take on or continue treating a client solely for financial gain; we only take on or continue to treat a client if we believe our services will have therapeutic value.

 

We do not accept payment or charge money for referrals.

 

We establish and maintain clear and honest business practices.

10. Competence

 

We agree to practice within our scope of competence, training, and experience specific to the populations we are working with and the modalities we offer.

 

We agree to represent our work honestly and accurately.

 

We assess at intake whether a potential client’s needs can be addressed within our scope of competence and, if not, make informed referrals to other providers and services.

 

We commit to ongoing professional development, seeking supervision and continuing education to further our therapeutic skills and presence.

 

We agree to maintaining our licensure and certification in good standing, including re-certification as required.

 

11. Relationship to Colleagues and the Profession

 

We establish and maintain compassionate and positive working relationships with colleagues, in a spirit of mutual respect and collaboration.

 

To maintain the highest integrity in our practice, we agree to seek counsel with our fellow practitioners and colleagues, being open to feedback when given, and offering feedback when it may be needed.

 

As practitioners of this modality, we are mindful of how we represent this work to the public, including through the media, social media, and public presentations.

 

12. Relationship to Self

 

We commit to ongoing personal and professional self-reflection regarding ethics and integrity.

We adhere to an ongoing practice of self-compassion and self-inquiry.

 

We agree to seek professional assistance and community support for our own emotional challenges or personal conflicts, especially when, in our view or in the view of colleagues, they affect our capacity to provide ethical care to clients.

 

We subscribe to the value of humility, out of respect for the transformative power of the experiences we have the privilege to witness and support, and out of respect for human dignity.

 

 

Adapted from: MAPS MDMA-Assisted Psychotherapy Code of Ethics    

Editors:  Shannon Clare Carlin, M.A. & Sarah Scheld, M.A.