A Perspective for Enhancing the Supervision of Psychedelic-Assisted Therapy: Motivational-Interviewing-Enhanced Integration Supervision (MIE-IS)

Abstract

While research on psychedelic-assisted therapy (PAT) continues to show promise, challenges in its clinical application persist. One relevant domain includes how supervision might enhance both client and trainee outcomes. Current data suggest that, despite supervisor reports and the enthusiasm of trainees, supervision accounts for extraordinarily little variance in treatment outcome. We propose that as supervisors model relevant skills, these skills can also improve in the therapist, which should lead to enhanced alliances and improved self-care for the client, trainee, and supervisor. Thus, we propose a model of supervision that rests on key Motivational Interviewing (MI) principles and supports the integration process—a pivotal phase of PAT where clients translate psychedelic-induced insights into meaningful behavioral change. This Motivational-Interviewing-Enhanced Integration Supervision (MIE-IS) model bridges the gap between psychedelic experiences and personal growth by ensuring supervisors can effectively encourage trainees to support their clients through this crucial integration process. Supervisors would model the use of MI with trainees in supervision, who would, in turn, apply those same MI technical and relational skills to support clients’ integration experiences. Beyond enhancing client outcomes, this supervisory model could also increase each trainee’s motivation to personally engage with wellness-promoting integration behaviors, potentially enhancing professional development and minimizing burnout. By reinforcing a culture of self-care and reflective practice, this model might inspire better self-care in supervisors as well. By fostering an MI-informed supervisory relationship, the model promotes a culture of continuous learning and skill development, benefiting clients through the effective and meaningful integration of their psychedelic experiences.

1. Introduction: Background and Rationale for Supervision in Psychedelic Therapy

Psychedelic-assisted therapy (PAT) is gaining continued attention as a promising approach for treating a variety of mental health conditions. Clinicians legally use ketamine off-label for mental health treatment in the USA, Canada, the UK, and Australia [1,2,3,4]. North American countries permit clinical trials for other psychedelics. Oregon and Colorado have legalized regulated psilocybin services; Canada permits psychedelic therapy under its Special Access Program. Several European countries, including Switzerland and the Netherlands, allow limited supervised use as well [1,5].

Unlike traditional psychotherapy, PAT involves altered states of consciousness induced by psychoactives, including psilocybin, 3,4-Methylenedioxymethamphetamine (MDMA), and ketamine. The therapy, however, includes more than simply administering the psychoactive molecule. PAT typically consists of three phases: preparation, monitored drug administration, and integration. Preparation provides education about the process and the medicine in detail while building rapport between the therapist and client. Drug administration includes a sitter who remains present to provide emotional and physical support throughout the acute effects. Sitters typically have experience with psychedelic-assisted therapy that includes training to encourage the use of eyeshades and music rather than active discussion during the session itself. Integration sessions, which focus on helping clients process and apply insights from their psychedelic experiences, are especially crucial for achieving lasting therapeutic benefits [6]. Subjective changes associated with acute administration provide novel experiences unique to PAT.

Supervising trainees so they can master these skills presents numerous challenges, some unique to PAT and some that overlap with general psychotherapy supervision. Given the breadth of both the psychedelic psychotherapy literature and the supervision literature more broadly, a comprehensive review of either is beyond the scope of this paper. Instead, we aim to highlight the key themes most relevant to the unique supervisory needs of psychedelic-assisted therapy and propose a targeted model that may help guide future training and research. We note that our new model focuses exclusively on integration. We discuss integration here as the process of reflecting on, making sense of, and applying insights gained from acute psychedelic reactions to relevant molecules in ways that support psychological growth and well-being. This usage is distinct from other meanings of “integration” in psychology, such as the integration of therapeutic modalities (i.e., combining techniques from different schools of therapy) or the integration of the self (i.e., synthesizing disparate aspects of personality or life events). While these meanings share a thematic emphasis on synthesis and coherence, our focus remains on integration related to interpretations of acute psychedelic reactions in adaptive ways.

Although initial investigations of PAT often labeled these sessions as “debriefing” rather than “integration”, most training models stress the import of these sessions for optimizing outcomes [6,7]. Other findings emphasize that the absence of these integration sessions and their associated enhancement of self-care is likely to minimize aversive or challenging responses after drug administration [8,9]. Other models of supervision account for little variance in outcome, as we detail below. We assert that those models might be too ambitious for PAT and encourage a more focused approach. For these reasons, we emphasize the supervision of integration sessions here, and stress that relevant models for preparation and administration might require considerably more information devoted to the specifics of those stages of the intervention.

Previous work has already provided thorough, detailed models for training therapists in PAT [6,7], but markedly fewer publications address the role of clinical supervision specific to this field. Clinical supervision is a structured, collaborative process in which a more experienced clinician (the supervisor) helps develop the skills, insight, and ethical practice of a clinician-in-training or peer (the trainee). Supervision typically aims to promote client welfare, build trainee competence, and ensure ethical fidelity. Supervision is ubiquitous in traditional psychotherapy training, attempting to ensure that therapists develop relevant competencies, adhere to ethical guidelines, and receive support in managing complex client dynamics. Given PAT’s unique challenges, including the navigation of altered states, enhanced client vulnerability, and the facilitation of integration, supervision is potentially even more critical than in standard psychotherapy. In PAT, the therapist’s role often shifts across phases—sometimes offering structure and containment, and other times allowing space for clients to lead with their own meaning-making. The lack of established models focused specifically on PAT supervision leaves a significant gap in the field, potentially affecting both trainee development and client outcomes.

In addition, renewed attention to reports of prolonged or under-reported adverse effects of psychedelics highlight the import of appropriate supervision. Adverse events might arise at random, or due to inadequate preparation, insufficient integration support, or the destabilizing effects of the psychoactives themselves [8,9]. These adverse events underscore the pressing need for structured supervision models tailored specifically to PAT. Supervisors who are well equipped to oversee PAT trainees can help mitigate these risks while fostering ethical, effective, and sustainable therapeutic practices. We assert that PAT will likely require tackling supervision issues that focus especially on integration because of the unique qualities of psychedelic molecules. Nevertheless, we hope to encourage discourse in all of psychotherapy supervision, including techniques devoted to addressing issues around other psychoactive molecules.

1.1. A Critical Review of Supervision in Psychotherapy

Research on the impact of clinical supervision on client outcomes in psychotherapy is hardly straightforward. Many researchers present clinical supervision as a cornerstone of therapist training across multiple mental health disciplines. The inclusion of supervision training as a licensure requirement underscores its perceived importance across psychology, social work, and counseling [10,11]. Supervision models often emphasize both supervisor and trainee growth, empathy, authenticity, and a focus on both the therapeutic and supervisory alliance [12,13,14]. Psychedelics have a reputation for generating growth, empathy, and authenticity as well [6]. Supervisors who model relevant skills could enhance trainee confidence, skill development, and professional identity, making supervision an integral part of therapist education. Indeed, both supervisors and trainees report that clinical supervision can contribute meaningful variance to treatment-induced improvements [15]. But these reports from supervisors and trainees do not appear to align with actual outcomes [16]. In fact, the data emphasize only very small effects of supervision on outcome. The shortcomings of supervision research are also severe. These shortcomings might prove particularly important to consider before generalizing them to PAT.

Despite widespread enthusiasm, research that evaluates supervision’s impact on client outcomes has produced, at best, mixed results. While studies suggest that supervision improves therapist confidence and self-efficacy [17,18], the direct effect on client treatment outcomes remains unclear. A study using a reliable measure of client progress [19] found that supervision accounted for only 0.04% of the variance in client outcomes [20]. A replication study in university counseling centers found that the impact of supervision on client outcomes was not only statistically insignificant but accounted for literally 0.00% of the variance in outcome [21]. These findings, supported by data from thousands of clients and hundreds of therapists, raise concerns about whether supervision, as traditionally practiced, meaningfully enhances therapy effectiveness. We believe that PAT supervision might face comparable challenges, suggesting that a focused, detailed model of supervision for one component (integration) might provide novel benefits.

These two findings that disconfirm the efficacy of supervision on treatment outcomes are not anomalies. Despite heartfelt enthusiasm among supervisors and trainees, multiple reviews over many decades consistently note the small effects of supervision on outcomes [18,22]. One review identified common supervision elements recommended across multiple professional associations, such as goal setting and formal evaluation [23]. Although some elements significantly improved measures of client impressions of treatment, methodological shortcomings weakened causal arguments. While supervision improved trainee competence, alliance, and self-efficacy, the link between supervision and client outcomes remained unclear or exceedingly small [18]. A review specific to cognitive behavioral therapy supervision reported that only one of five studies documented a positive impact of supervision on treatment outcomes [24]. A meta-review of 20 previous reviews emphasized the weak empirical evidence for supervision’s impact on outcomes as well [18]. If supervision has a direct effect on outcomes, we have yet to identify it.

Critics of these reviews abound, however. They often argue that these findings do not necessarily indicate that supervision is ineffective so much as underscore that existing supervision models do not posit direct effects on client outcomes. Rather, critics argue that the intent behind supervision is to improve trainee competencies. But causal arguments for supervision’s impact are poor, and numerous methodological problems prevent support for this claim. Supervision research often includes correlational designs, outcome measures contaminated by shared method variance, and a lack of longitudinal designs. Few studies assign therapist trainees to supervisors at random, making causality hard to establish [23,24]. In addition, excessively broad supervision models that attempt to encompass all forms of therapy for all client complaints might dilute key variables that contribute to effectiveness. Perhaps suppressors and moderators remain unidentified. Research on PAT supervision could improve dramatically by incorporating these methodological recommendations, including the use of multiple independent raters, random assignment of trainees to supervisors when feasible, longitudinal designs, and more focused supervision models tailored to specific therapeutic modalities and client concerns.

Considering these concerns, a tailored model of supervision that focuses on how to improve both trainee and client outcomes during a specific treatment phase within a specific intervention might yield stronger empirical support. In the context of PAT, supervision focused on enhancing a critical phase of treatment (integration) offers a direct path to improved outcomes. Integration often solidifies the therapeutic work that clients perform during PAT [25]. Supervision that strives to enhance therapists’ ability to facilitate the integration process could effectively bridge the gap between psychedelic experiences and lasting psychological growth. With refined supervision practices that target specific therapeutic processes within an intervention, the field can move beyond the notion that a supervisor’s years of experience alone lead to trainee competency and client well-being. A model that focuses on integration exclusively can help researchers sidestep some of these problems, as we will detail.

1.2. Proposing a Motivational-Interviewing-Enhanced Integration Supervision Strategy for PAT

Given these challenges, a new supervision model must address both the need for structured guidance in PAT and the lack of empirical support for existing supervision frameworks. Summarizing all of clinical supervision would require multiple volumes, but we highlight some key components in

Table 1. Stereotypical traditional supervision and additional elements.

Supervisory Feature	Stereotypical Traditional Supervision	Additional Elements in MIE-IS
Primary goals	Develop skills, uphold ethical standards, support client welfare [12]	Support meaning-making in integration sessions; promote autonomy and values-congruent growth for the trainee
Supervisor stance	Supportive expert, evaluator, gatekeeper [26]	Adds collaborative, evocative stance rooted in Motivational Interviewing [27]
Trainee development	Focuses on competency, protocol adherence, and insight into client dynamics	Builds capacity to navigate ambiguity in integration; supports reflection on trainee’s stance toward nonordinary experiences
Client representation	Typically case-based, often represented through clinical data and symptom reports	Emphasizes client as co-creator of integration meaning; attends to client autonomy and values within supervision conversations
Content focus	Case conceptualization, diagnosis, treatment planning, ethical challenges	Adds focus on psychedelic-specific integration challenges (e.g., ontological shock, spiritual insights, ineffability)
Session process	Supervisor-guided discussions, often structured around competency checklists or case reviews	Includes MI-consistent elements such as open questions, reflective listening, exploring ambivalence about integration themes
Theory integration	Often draws from evidence-based treatment models for case formulations	Integrates MI theory and spirit (collaboration, evocation, autonomy support) with psychedelic-specific integration needs
Outcome orientation	Evaluates supervisee’s effectiveness and ethical practice; monitors client outcomes	Adds emphasis on supervisee’s ability to support flexible, personally meaningful integration for clients navigating altered states
Attention to therapist and supervisor experience	Often implicit or addressed only when problems arise (e.g., burnout, reactivity)	Explicitly incorporates reflection on therapist’s inner experience, meaning-making, and values alignment; invites supervisors to model presence, flexibility, and curiosity

, including primary goals, supervisor stance, trainee development, client representation, content focus, session process, theory integration, outcome orientation, and attention to therapist and supervisor experience. The traditional, or at least stereotypical models, tend to align with the topics described [12]. We are not asserting that all clinical supervision ends up exactly as we describe here, but relevant manuals and data suggest that a great deal of clinical supervision contains some of these components.

We propose building from these characteristics of supervision to generate an innovative approach. Unlike traditional supervision models, which can rely on directive feedback, hierarchical oversight, or undocumented expertise, the Motivational-Interviewing-Enhanced Integration-Specific (MIE-IS, pronounced “my is”) model integrates Motivational Interviewing (MI) techniques directly into the supervisory process. We have invented this approach in the hope of generating relevant discourse, empirical work, and action, rather than proclaiming it as the definitive framework. Motivational Interviewing is a collaborative, client-centered approach that helps individuals explore and resolve ambivalence to support behavior change in line with their values. In this case, the target behaviors involve the functioning of the triad of supervisor, trainee, and client. Successful outcomes will include not only improved functioning in the client but also enhanced skills in the trainees and supervisors, with self-care remaining appropriate for all three people. In a nutshell, the supervisor models relevant skills to help the trainee improve in them, enhancing their alliance and outcomes (see Figure 1). Please note that this model contrasts with many forms of supervision that simply rely upon a supervisor providing information to a trainee who then adds relevant psychoeducation in a session with a client. This new approach emphasizes creating therapeutic experiences rather than providing information.

Thus, this model does not assume that experience alone improves therapist competency. (In fact, in one large study of standard, non-psychedelic therapy, treatment outcomes actually decreased significantly as therapist experience increased; [16].) Instead, this model offers structured, evidence-based strategies for strengthening therapeutic alliances and integration skills. Supervisors who model MI principles within supervision create a framework for trainees to understand how to, in turn, apply these principles to benefit their clients. A deeper understanding bolsters trainee confidence in their ability to guide clients through integration while also engaging in reflective practices that promote their professional growth and self-care. We note that, although supervisors would rarely, if ever, speak directly to clients, their actions would impact client outcomes both directly and indirectly via changes in therapist behaviors. In a sense, our unit of analysis is the triad of supervisor, therapist, and client. Enhancing the functioning of this triad becomes the goal of the supervision.

MI offers a promising solution for bridging the gap between supervision and treatment outcomes, particularly in the context of integration-focused supervision. MI is a well-established, evidence-based approach that enhances intrinsic motivation for behavioral change by emphasizing collaboration, empathy, and client autonomy [27]. Moreover, MI consistently appears in behavioral health settings to support self-efficacy and foster engagement with treatment, making it a strong candidate for enhancing integration practices in PAT. Treating supervision sessions as an opportunity to enhance a trainee’s motivation to engage in relevant care and self-care might seem like a reasonable extension of MI’s impact on other behaviors, many of which are more complicated and demanding (like quitting alcohol, for example). With these considerations in mind, we introduce the MIE-IS model, outlining its core components and implementation.

2. A Model for Supervision in PAT

We suggest that supervision in PAT focus on enhancing engagement for supervisor, trainee, and client so that all maintain regular reflection and application practices that can facilitate integration. Ideally, supervisors would model the relevant MI skills to help trainees reflect on their own relevant experiences and apply insights into their own self-care. These interactions would then serve as a model for trainees to do the same with their PAT clients. In addition, by building on strengths and providing accurate feedback, supervisors can enhance each trainee’s self-efficacy to encourage them to enhance the reflection and application with their clients. Note that these recommendations contrast with those underscored in Table 1.

Several key elements of MI are especially relevant to PAT supervision, though they make good practice in almost any supervisory relationship. Psychedelic experiences often evoke deeply personal, emotionally intense, and hard-to-verbalize content. MI’s emphasis on reflective listening and evocation can help supervisors guide trainees in supporting clients as they process these ineffable experiences. This client-centered approach can allow them to provide this guidance without imposing interpretations or prematurely structuring meaning. This restraint is especially crucial in PAT, where psychedelics have the potential to increase suggestibility, and client autonomy in meaning-making is a core ethical concern.

Further, MI’s collaborative, non-hierarchical stance aligns well with the unique demands of PAT supervision, where strict protocol adherence must often balance with intuitive responsiveness. Supervisors who model this collaborative spirit can help trainees navigate the nuanced relational dynamics that arise in altered states of consciousness, which might challenge conventional therapeutic roles. Finally, MI’s focus on supporting practitioner self-efficacy and values-consistent behavior becomes particularly salient in PAT, where therapists might carry increased emotional weight due to the intensity of client experiences. The capacity to model and foster self-care within supervision can help sustain therapist resilience and preserve ethical sensitivity over time.

2.1. Targeted Behaviors for PAT Supervision

Given MI’s established effectiveness in promoting health behaviors, comparable approaches are likely to enhance the behavioral aspects of integration in PAT. The interventions need not be limited to the alleviation of symptoms of common disorders [28]. While specific integration practices require further research, qualitative data suggest that integration bridges psychedelic experience with everyday life and promotes lasting behavioral change [25]. Although initial investigations of PAT often labeled these sessions as “debriefing” rather than “integration”, most training models stress the import of these sessions for optimizing outcomes [6,7]. Other findings emphasize that the absence of these sessions and their associated enhancement of self-care is likely to minimize aversive or challenging responses after drug administration [8,9]. Supervision that also emphasizes self-care for both trainees and supervisors can reduce stress and increase satisfaction, even during challenging periods with clients [29]. Any supervision process that could enhance integration, especially while emphasizing self-care in providers, could benefit the field over time. Even small improvements in relevant skills and trainee self-care would have the potential to accumulate over the years of a career [30].

Small, experience-based improvements that accumulate over time raise important hypotheses about the role of personal psychedelic use among therapists and supervisors. Prior work has examined this issue in more detail [30], but relevant data suggest that most PAT therapists already report personal psychedelic experience [31]. Many training programs encourage experiential work as a part of the development of relevant competencies [7]. Potential clients report that a therapist’s personal experience matters to them, often as much or more as the therapist’s gender, ethnicity, and previous symptoms [32]. These findings might reflect assumptions about the value of experiential learning, especially in contexts where verbal instruction cannot fully capture the nature of the work. Acute reactions to psychedelics often resist easy description. Clients might feel more understood when therapists possess firsthand knowledge of similar states. Shared experience can also lead to more fluent communication. When both therapist and client have encountered similar altered states, they might find it easier to exchange meaning around otherwise ineffable moments.

Nevertheless, critics of the idea of required personal experience emphasize that therapists can acquire relevant skills through structured training, observation, and supervision. Alternative approaches to altering consciousness, including hypnosis, meditation, breath work, and sensory deprivation might provide parallel experiences. Procedural learning like this often develops through guided practice and repetition, even when direct personal experience remains absent. Testing the effects of personal psychedelic use with a randomized design would require considerable resources and might raise ethical challenges. A fully powered study would need to involve at least 80 therapists, each treating 30 clients, to detect differences in outcomes related to personal psychedelic use [30]. No existing trial in this area has met that standard. This paper does not argue that personal use must occur for effective therapy or supervision. Instead, we aim to outline the complexity of the issue and clarify the current limits of the available evidence. Given the potential impact of personal psychedelic use on communication between therapist and client, however, we must emphasize that the same issues apply to relevant communication between supervisor and trainee.

Recent research on integration can help us to identify appropriate behavioral targets for improving well-being post-dosing, including reflection on the psychedelic experience and the application of reflection-induced insights. The extensive development of the Integration Engagement Scale (IES) and Experienced Integration Scale (EIS) offers structured approaches for addressing psychedelic integration behaviors that align with recommendations for success and impressions generated from integration therapists [25,33]. These instruments can inspire in-session discussions, as well as personal reflection outside of sessions via journaling, silent contemplation, consuming relevant media, and spending time in nature.

The time devoted to reflection can then inform the application portion of integration. Application focuses on new behaviors that arise from the insights that appear during psychedelic experience or in related debriefing. This distinction between reflection and application underscores the importance of translating experiences into action. The relevant behaviors often depend upon choices that align with individual values. Thus, they can vary dramatically for each client, trainee, and supervisor. Standard improvements in self-care, including sleep, diet, and exercise, might serve as handy, general examples. Increases in behavioral activation more broadly appear to covary with ayahuasca-induced improvements in depression [34]. These behavioral changes seem essential.

In addition, the EIS focuses on intrapersonal functioning via three domains: feeling settled, harmonized, and improved [33]. Feeling settled serves as an indicator of successful processing and integration of the encountered emotions, experiences, and insights. The harmonized domain reflects the alignment between the experience and one’s current actions, revealing that internal shifts have translated into coherent new behaviors. Feeling improved, in contrast, encompasses tangible benefits, including increased self-awareness and well-being. These measurement devices would serve as part of the assessment of client progress. The scales provide a structured approach to understanding and measuring psychedelic integration, supporting the development of informed and effective practices [33]. Trainees can turn this information into client improvement in straightforward ways.

The IES and EIS highlight the importance of both reflection and application in integration, aiding supervision practices. With these measures in mind, we propose that the optimal supervision of PAT integration first involves emphasizing a combination of both reflection and application. Reflective practices, including journaling, meditation, and discussions with supportive individuals, help deepen understanding and integrate insights. In a sense, supervision sessions become a discussion with a supportive individual in comparable ways.

Application involves translating these insights into everyday actions, which would manifest as choices driven by values. These actions could manifest as specific activities like spending time in nature, maintaining healthy relationships, and prioritizing wellness.

The items from the scales can also serve as targets for supervision. Supervision that encourages trainees to, much like their PAT clients, journal, meditate, and discuss related insights with others, seems intuitively appealing. Applications might also be relatively straightforward. Trainees would prioritize wellness, appropriate boundaries, and leisure time that provides opportunities for awe [35]. Astute supervisors would also do the same.

Supervisors who model and encourage the proposed, targeted behaviors, including those addressing reflection and application, would have multiple advantages. These advantages can foster a supportive environment for both trainees and clients, emphasizing wellness and personal growth in their daily lives. These might enhance one another in synergistic ways. We propose that, as the supervisor models relevant skills, these should also improve in the therapist, which should lead to enhanced alliances and improved self-care (see Figure 1).

2.2. Using MI to Engage Clients and Trainees in Integration Practices

Integrating MI skills into the supervision and psychotherapy processes can enhance client engagement in integration activities in ways that likely parallel its impact on other health behaviors [27]. This approach can be applied in psychedelic-assisted treatments, despite their novel facets, thanks to their reliance on broad, humanistic, and cognitive–behavioral principles [28]. Supervisors using MI strategies can model effective MI techniques for trainees, empowering them to employ comparable skills with their clients.

We could detail a subset of relevant skills here, but these behaviors rely upon the spirit of MI, which rests on the principles of partnership, acceptance, compassion, and evocation [27]. Partnership emphasizes a collaborative relationship where both practitioner and client (or client and trainee) work together as equals. Acceptance involves maintaining a nonjudgmental attitude, respecting the person’s worth, understanding their perspective, supporting their autonomy, and affirming their strengths. Compassion requires prioritizing their welfare, demonstrating genuine concern, and showing a commitment to diminishing their troubles. Evocation focuses on drawing out a person’s desires, strengths, and resources for change, emphasizing their intrinsic motivation and agency. Together, these principles create a supportive, empathetic, and empowering environment for supervision and for PAT. This MIE-IS supervision could create a safe space where trainees feel supported and understood, which they can then generalize in ways that could make their PAT clients also feel supported and understood.

With these principles in mind, key MI strategies, applied within the spirit of MI, include expressing empathy, developing discrepancies between articulated values and inconsistent actions, listening actively, and supporting self-efficacy. These appear in detail in the latest edition of Motivational Interviewing [27]. By using comparable strategies, supervisors can help trainees build the confidence to apply these skills to address client ambivalence, especially about engaging in targeted integration behaviors. Resolving ambivalence could foster relevant intrinsic motivation.

MIE-IS supervision might address developing the discrepancy between stated desires or aims and current client (or trainee) behaviors. A supervisor might make this disparity salient using a parallel approach with their trainee. By emphasizing an accepting, nonjudgmental communication style consistent with the spirit of MI [27], or in focused psychedelic-assisted interventions [28], the supervisor can model ideal behaviors for the trainee. A trainee who has yet to make a client’s disparity salient likely has the desire to do so, essentially mirroring a comparable disparity. By developing discrepancies, supervisors assist trainees in highlighting the differences between a client’s current behaviors and their desired outcomes, potentially enhancing motivation for change. Developing this discrepancy might require that supervisors help trainees recognize the gap between their own current practice and the optimal integration behaviors that they might envision for their clients.

Note how this approach encourages trainees to arrive at their own conclusions and generate options consistent with their values. This MIE-IS supervision process likely requires more time than supervision approaches that require directive, straightforward recommendations or exhortations. Nevertheless, it also appears less likely to generate reactance. In addition, the ideas that the trainees generate for themselves probably align with their perceptions of their own skills, abilities, and aims. This trainee-centered approach to supervision can parallel the client-centered approach to integration. The details of how the trainee would begin and maintain journaling, for example, might prove dramatically different from comparable details with the client, but the process likely contains compelling parallels that simpler recommendations, especially directive ones, might lack.

Supervisors would provide this guidance about reflective listening by using reflective listening. This approach would guide trainees in using reflective listening in their own sessions to explore each client’s feelings about the integration activities. The trainee’s reflections could help clients articulate their own reasons for increasing these behaviors. Rather than viewing the reflections (and other strategies) as techniques, we emphasize how the overarching goal of communicating an understanding of the trainee’s quandaries and challenges would serve as the top priority. In many ways, the process includes not only what to say, but how to say it.

Supervisors must navigate a complex relational matrix that supports trainees’ professional development while simultaneously attending to the care of clients, the standards of the field, and the emotional demands of psychedelic work. Supervisors could attend to the overarching goal of communicating understanding rather than simply emitting the behaviors that have become cliches for reflection. The trainee’s process in sessions (and the supervisor’s behavior in supervisions) can be markedly more complex than repeating or paraphrasing recent utterances. Reflecting affect using complex reflections and relying on double-sided reflections (which present both sides of a dilemma potentially related to behavior change) can have dramatic potential during supervision [27]. This type of reflective listening requires more than accurately mirroring statements. The procedural learning necessary would likely benefit from modeling and consistent repetition in supervision sessions.

Supervisors would also explore the trainee’s underlying meaning and feeling in a way that encourages comparable explorations in integration sessions with clients. This process would not only help trainees feel heard but also demonstrate how to use these skills with clients. Thus, even in the absence of extremes in expressed affect, supervisors might use the vocabulary of affect to normalize feelings of frustration or disappointment. (This negative affect can frequently accompany sessions where clients seem stuck.) This approach provides trainees with an opportunity to express relevant emotions before brainstorming about their next steps. Acknowledging these feelings might encourage new perspectives on integration sessions. “Edge emotions”—the intense feelings associated with challenges to beliefs and perspectives—might prove particularly relevant. Modeling the adept management of uncertainty and discomfort can be similarly effective in both supervision and integration sessions [18].

Supervisors might also report understanding how trainees might feel uncertain about encouraging clients to journal, for example. This understanding could then encourage exploration of options for addressing this target behavior. Encouraging trainees to journal themselves can illustrate the potential ambivalence and difficulties in unparalleled experiential ways. Identifying facets of stimulus control, including a scheduled time and location for the journaling as well as the consideration of reinforcers and related cognitions, would enhance the client’s chances of engaging in this targeted integration behavior. Note that, despite how behavioral these components appear, they are likely to enhance empathy for the process. The trainee might list multiple options, including many that the supervisor might not have generated. Exploring these options together could model a comparable process for how trainees could do the same with clients. In a sense, this behavioral intervention will depend upon broad, humanistic principles.

In these circumstances, trainees might note an improved understanding of motivation and challenges related to integration behaviors, especially if they engage in corresponding ones themselves [36]. A therapist who is journaling can likely empathize with clients who are also journaling, for example. Supervisors who can provide this encouragement based on their own personal, ongoing experience might have distinct advantages in both empathy and credibility. In contrast, supervisors who do not attend to their own self-care might find their trainees and clients unwilling to attend to theirs. Complete training in MI for both supervisor and trainee would seem important. We hope that the perspective detailed here might inspire a thorough review of the relevant key principles.

This approach supports self-efficacy, a core construct in Motivational Interviewing, for both trainees and clients. Supervisors can encourage trainees to recognize and build upon client strengths, reinforcing their belief in their ability to guide integration activities skillfully. At the same time, supervisors can highlight trainees’ own strengths, fostering confidence and reinforcing past successes. Beginning supervision with specific praise for what trainees have done well can set a collaborative tone and increase openness to feedback. Emphasizing strengths, knowledge, and prior accomplishments might offer particular benefit in the context of psychedelic-assisted treatment, where trainees often face unusual client content and heightened ambiguity. A strong sense of competence can help them maintain presence without needing to impose interpretation. This kind of support might also increase supervisors’ own satisfaction by focusing attention on the developmental growth they help facilitate. Prior work offers complementary guidance for strength-based supervision practices [37,38].

3. Conclusions and a Clarion Call for Research

A randomized controlled trial comparing MIE-IS supervision with traditional supervision models in PAT trainees could help determine whether this approach leads to stronger alliances, better client integration, and improved outcomes. Data already reveal that clinical supervision enhances therapist-level variables like perceptions of competence or confidence but has limited direct impact on client outcomes. Supervision also appears to have potential for minimizing therapist burnout, but empirical support for this idea appears only rarely. The exact content of supervision sessions can be hard to glean even from the largest clinical trials. Relevant theories and models have intriguing implications but do not always translate into straightforward, falsifiable hypotheses with empirical support.

Supervision for PAT has received even less attention. Given the complexities of the process, we suggest focusing on only one stage of treatment for an initial empirical investigation of a model of supervision. The available models of the complete PAT process and relevant training have intriguing implications for a focus on supervision. We propose a narrow but falsifiable alternative in MIE-IS. This type of supervision targets specific skills for increasing the integration behaviors with the most promise for enhancing outcomes. Supervisors model Motivational Interviewing strategies in supervision sessions. These strategies encourage trainees to engage in behaviors that parallel the integration (and self-care) behaviors that they will encourage in their clients. Despite this narrower focus, MIE-IS has potential to boost client outcomes and generate falsifiable hypotheses with implications for supervision research. Relevant MI skills should increase in both supervisors and trainees. Appropriate reflection and the application of the insights based on that reflection should increase in supervisors, trainees, and clients. All should flourish as treatment progresses.

This model underscores the importance of self-care for both trainees and supervisors, as previous research and theorizing on integration have suggested. The approach advocates for continuous learning and skill development. Ultimately, this MI-informed supervisory relationship can promote the effective and meaningful integration of psychedelic experiences for clients, while buffering trainees against burnout, by enhancing self-care. Future research investigating the nuanced effects of supervision on client outcomes can refine and optimize these practices. Such work could enhance PAT outcomes, prevent therapist burnout, and benefit the community broadly. Should these paths from supervision to outcome receive empirical support, subsequent theorizing and more elaborate models might build from there. Focusing on empirically supported strategies for enhancing specific integration behaviors might reveal a meaningful link between supervision and treatment outcomes in PAT. Previous reviews suggest that such an established link would be a first [18,20,21]. Subsequent theorizing might account for even broader psychedelic-assisted processes underlying induced improvements. But perhaps most importantly, the approach could decrease suffering in clients while supporting good self-care in providers.