Psychedelics · 2022
EMBARK (Psychedelic Therapy)
Psychedelic change may unfold along multiple experiential routes that the therapy prepares for, accompanies and integrates without imposing in advance a single explanation of how the person should heal.
EMBARK is an integrative model of psychedelic-assisted psychotherapy developed by William Brennan and Alexander B. Belser as a transdiagnostic, trans-drug framework capable of organising psychotherapeutic support before, during and after a psychedelic experience. Its architecture attempts to resolve the tension between models of basic support, which preserve experiential freedom but may lack a sufficiently operationalised theory of change, and models that incorporate a single evidence-based therapy, which provide structure but may restrict the interpretation of highly variable psychedelic experiences. EMBARK proposes six parallel clinical domains — Existential-Spiritual, Mindfulness, Body-Aware, Affective-Cognitive, Relational and Keeping Momentum — representing possible routes to therapeutic benefit, and combines them with four care cornerstones — Trauma-Informed Care, Culturally Competent Care, Ethically Rigorous Care and Collective Care — that regulate the whole intervention ethically and contextually. The treatment retains the usual structure of preparation, medicine session and integration: during preparation, conditions are established so that any of the six domains may acquire relevance; during the psychedelic experience the therapist adopts a principally responsive position, identifies the phenomena that emerge and uses interventions compatible with the clinical domain activated; during integration it is determined collaboratively which changes of meaning, emotion, body, relationship, behaviour, values or context are worth consolidating. Flexibility is a central property of the model: therapists may incorporate competences from orientations they have previously mastered provided they respect EMBARK's clinical functions, ethical limits and principles, preserving the participant's autonomy and avoiding the imposition of a predetermined meaning on their experience.
Theory of change
The person changes when a potentially transformative psychedelic experience can be prepared for, gone through, given meaning and incorporated into their life through the routes of change that prove genuinely relevant to them.
Core ideas
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Psychedelic change may follow multiple therapeutic routes
EMBARK starts from the premise that a psychedelic experience may acquire therapeutic value through very different phenomena and that psychotherapy loses opportunities when it recognises only those fitting a previously chosen theory. The Existential-Spiritual, Mindfulness, Body-Aware, Affective-Cognitive, Relational and Keeping Momentum domains function as parallel conceptualisations of benefit and allow the treatment to adapt to what actually emerges for each participant. Plurality therefore constitutes a positive theory of change and not an absence of formulation. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy; Brennan & Belser, 2024, EMBARK Psychedelic Therapy for Depression).
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Preparation should widen possibilities without predicting the experience
During preparation it is still unknown which domain will prove most relevant, and EMBARK therefore prepares across all the principal routes to benefit. Intentions, mindfulness, somatic awareness, emotional approach, relationship and subsequent change are introduced as available resources, not as a script the participant must perform during the session. This breadth makes it possible to arrive at the experience with sufficient tools without unduly directing its content. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy).
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The medicine session demands responsiveness rather than a rigid psychotherapeutic agenda
Once the substance has been administered, the function of the six domains changes: they cease to be principally a preparatory structure and become a rubric for recognising what kind of phenomenon is taking place and what competence may be useful. The therapist responds to the specific experience and preferentially uses resources already prepared with the participant, maintaining a contained presence and avoiding steering them towards the outcome expected by any particular therapeutic school. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy).
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The body may constitute a route of change and not merely a source of adverse effects
EMBARK broadens psychedelic psychotherapy by recognising that sensations, movements, changes of energy and modifications in the relationship with the body may have clinical relevance for some participants. The Body-Aware domain prepares somatic awareness and resources for regulation and makes it possible to respond to these phenomena during the experience without automatically reducing them to unwanted symptoms or attributing to them undemonstrated therapeutic mechanisms. This inclusion corrects a limitation that Brennan and Belser identified in much of the earlier work. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy; Brennan & Belser, 2024, EMBARK Psychedelic Therapy for Depression).
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The therapeutic relationship may be amplified and become simultaneously an opportunity and a risk
Psychedelic states may increase vulnerability, interpersonal sensitivity, suggestibility, transferences, needs for proximity and the testing of limits. EMBARK holds that these conditions may facilitate new experiences of trust and relational repatterning, but may also markedly increase the potential for exploitation or harm. The Relational domain is therefore inseparably tied to ethical rigour, consent, clear boundaries and the therapist's self-reflection. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy).
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The meaning of the experience belongs primarily to the participant
EMBARK's interpretative flexibility protects the participant's capacity to define what particularly intense spiritual, emotional, bodily or relational experiences mean. The therapist may help to describe, contextualise and relate those events to clinical goals, but the heightened suggestibility associated with psychedelic states makes the imposition of personal beliefs a particularly serious clinical and ethical risk. Hermeneutic autonomy thus constitutes a central component of the model. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy; Brennan & Belser, 2024, EMBARK Psychedelic Therapy for Depression).
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Integration transforms an intense experience into sustained change
EMBARK distinguishes between having a potentially significant experience and getting that experience to change one's life lastingly. Integration debriefs what happened, relates the phenomena to symptoms and intentions, identifies new attitudes, beliefs, values, relationships or behaviours, and selects concrete goals for consolidating them. Keeping Momentum expresses with particular clarity that the clinical value of an insight depends largely on what the person can do with it afterwards. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy; Brennan & Belser, 2024, EMBARK Psychedelic Therapy for Depression).
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Change may require modifying behaviour, personal context or structural context
Integration goals are distributed across three spheres because EMBARK holds that suffering and its maintenance do not reside exclusively within the individual. Some experiences require modifying habits; others point to relationships, work or immediate contexts incompatible with well-being; others make visible social or structural conditions that no intrapsychic technique can remove. This broadening avoids turning all contextual suffering into an individual dysfunction and allows integration to include community or collective action where these are freely chosen and clinically coherent. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy).
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Ethics is part of the technique of psychedelic psychotherapy
EMBARK places consent, boundaries, power, touch, supervision, self-reflection and the prevention of transgressions within the architecture of the treatment, because the psychedelic context may magnify both the beneficial impact and the harm produced by the relationship. Ethically Rigorous Care requires the therapist to examine their own participation continuously and organisations to have structures capable of preventing and responding to transgressions. Clinical competence is incomplete when it does not incorporate this specific ethical dimension. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy).
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Trauma and culture run through every domain of the treatment
Trauma-Informed Care and Culturally Competent Care function as cross-cutting foundations and not as modules reserved for particular patients. An apparently simple practice of mindfulness or bodily awareness may have very different effects on a person with a history of trauma, and a relational, spiritual or touch-based intervention may acquire radically different meanings according to culture, identity and history of power. EMBARK requires each domain to be adapted to these conditions in order to preserve safety, autonomy and clinical relevance. (Brennan & Belser, 2022, Models of Psychedelic-Assisted Psychotherapy).
Influences
- Psychedelic-assisted psychotherapy
- Acceptance and Commitment Therapy
- Cognitive behavioural therapy
- Mindfulness-Based Cognitive Therapy
- Rumination-Focused Cognitive Behavioral Therapy
- Dialectical Behavior Therapy
- Mindfulness-Based Relapse Prevention
- Emotion-focused therapy
- Somatic approaches
- Relational psychotherapy
- Trauma-informed care
- Cultural humility
- Clinical ethics
- Social and structural perspectives on mental health
Key references
- Brennan, W., & Belser, A. B. (2022). Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Frontiers in Psychology, 13, 866018. https://doi.org/10.3389/fpsyg.2022.866018
- Brennan, W., & Belser, A. (2024). EMBARK Psychedelic Therapy for Depression: A New Approach for the Whole Person. Oxford University Press.
- Hulser-Morris, E., & Pilecki, B. (2024). Embark psychedelic therapy for depression: A new approach for the whole person. Journal of Psychedelic Studies. https://doi.org/10.1556/2054.2024.00423
- Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. SMA 14-4884.