Working in a Co-Therapy Dyad

“Ideally, co-facilitation requires mindful attention to the experience of self and other, maintaining an open and receptive stance to whatever arises during the psychedelic journey.”

—Patricia Rockman (2022, personal communication).

Depending on the type of psychedelic-assisted therapy you are delivering, you may have the opportunity to work within a co-therapy dyad.

Co-therapy is essential for psychedelic-assisted therapy that has a duration of 4 hours or longer, as it offers additional support for both client and therapist for sessions of extended duration.

The Numinus Perspective

Numinus psychedelic-assisted therapy services that employ co-therapy currently include MDMA- and psilocybin-assisted therapy. Numinus ketamine-assisted therapy protocols involve ketamine sessions of 2.5 hours duration, and these are considered appropriate for a single therapist.

Benefits of Working with a Co-Therapist

When co-therapy teams can cultivate excellent alliance and rapport, one’s co-therapist becomes an ally, supporting one another’s ongoing engagement and presence in the therapy session. Working with a co-therapist offers the opportunity for rest by taking turns remaining with the client while the other therapist takes a short snack break or uses the washroom.

A co-therapist also provides a physical second presence of a regulated nervous system to provide a strong field of co-regulation for charged content that invariably surfaces for the client. The presence of two therapists with different physical characteristics and presentations also affords the opportunity for a broader range of transference dynamics to emerge in the session which can provide meaningful opportunities for therapeutic work. The co-therapy dyad may also be beneficial if one member of the co-therapy team is triggered into a countertransference response or other emotional trigger due to factors such as shared trauma history with the client.

When members of a co-therapy dyad know one another well, and have shared information regarding personal stressors and triggers, they can take turns stepping forward in the therapy dynamic if the other needs space to self-regulate, re-align, and re-ground.

Potential Challenges of Working with a Co-Therapist

However, the co-therapy dynamic also has the possibility to increase stress, as it is another relationship to manage that can easily become charged due to the intensity of psychedelic-assisted therapy.

For this reason, we encourage co-therapists to:

Be self-aware regarding personal insecurities, comparisons, competitiveness, familial dynamics, gender roles, power dynamics, or past unresolved relational patterns that the dynamic with your co-therapist may be bringing forward within you.

Consider how you handle intimacy prior to embarking upon co-therapy. The relationship you have with your co-therapist may involve increased intimacy beyond typical collegial relationships. Capacity for platonic intimacy is paramount for a successful and safe co-therapy dynamic for both therapists and for the client who is the open recipient of the intersubjective field co-created by the therapy dyad and the dynamics therein.

Share and reflect about your communication styles, connection blueprint or attachment style, and conflict resolution strategies. Engage with a supervisor together on a regular basis to ensure that a relationship with a supervisor is built before any potential incidents occur that require supportive intervention or conflict management.

Co-Therapy Preparation

The following is a list of questions that we advise you discuss with your co-therapist before working together:

Co-Therapy Debrief

A co-therapy debrief should be built into the time allotted for the psychedelic-assisted session once the client has left the space. At least 15 minutes should be spent reviewing: