What I Mean When I Say "Psychedelic-Friendly Psychiatrist"
I've been trying to explain what I do and love to do. And so, I’ve taken to calling myself a "psychedelic-friendly" psychiatrist, and I realize that phrase could mean a lot of things depending on who's saying it. There is no one thing this means. There wasn’t quite a name for it yet.
So I want to be specific about what I mean by it, because I think specificity matters in a space that's drowning in vague language.
I'm not running a ketamine clinic. Not ketamine infusions or Spravato for depression. I'm not even currently offering KAP (ketamine-assisted psychotherapy), though I'd love to - I don't have a physical office right now, and I believe journey work must be done in person. I don't offer psychedelic therapy, for multiple reasons (it's clinically and ethically not ready for primetime by clinicians a nuanced topic for another time). I didn't hang a shingle that says "psychedelic psychiatrist" after a weekend certification.
What I do is practice psychiatry: medication management, ongoing psychotherapy, the whole thing. With the understanding that psychedelics are part of the conversation. And with deep respect for what we're learning about them, from all angles: from research to the shamanic.
How this actually comes up
Someone's been working with a therapist and doing ketamine-assisted sessions through a separate clinic, but their prescriber doesn't know about it. Or they do, but doesn't know much about it or the depth of how it might work. Now their psychiatric care and their psychedelic work are happening in two different worlds that don't talk to each other.
Or they're curious about ketamine and they've seen the ads from the companies that ship it to your door. Something about that doesn't sit right with them, and they want to talk to an actual person who will think through it with them rather than sell them on it.
Or maybe someone is planning a psilocybin experience either on their own or at a retreat in Oregon. They want to know how it interacts with their SSRI, or get guidance on how to taper their medication beforehand, or which meds to hold on the day of. If they don't already have an informed therapist or coach, there are things to discuss in terms of preparation and integration, which is where the meat of the work really lies. They want someone who can hold both the clinical picture and the experiential one.
Maybe someone has an experience and now they're looking for someone who gets it, who can either refer to integration resources or help them directly. Some people lower medications after experiences. Some stay the same. Some actually come from ceremonies learning, "Oh gosh, medications are actually helpful, let me start or resume them." A lot of the new-age world I interact with in my own explorations (another rich topic!) has an explicit or implicit anti-med bias, and part of my goal is to help soften and balance that.
Maybe they're too nervous about using substances to alter their perceptions: they’re terrified of "seeing things," or maybe it's clinically inappropriate right now. But they'd like to explore something in a similar vein: shamanic practices, somatic practices, breathwork. Something that opens a different door without the substance piece.
I like to joke that brainspotting and certain types of breathwork can be "psychedelics sober": they use focused attention or breathing to access subcortical, non-logical states that are often what's actually working in good therapy and a lot of the psychedelic process. I use brainspotting extensively in my own practice; for breathwork and shamanic work, I'm not a practitioner myself, but I work with people who are exploring all of it as part of their personal process.
What I've trained in and what I'm honest about
I've had "above-ground" training in ketamine-assisted psychotherapy through apprenticeship and Polaris. The CIIS Certificate in Psychedelic Therapy and Research. Psilocybin research facilitation. As well as "underground" training, my own experiences and learning from mentors and teachers, which no certificate quite captures. This is where much of my deepest learning comes from.
I recently had a conversation with a colleague where we realized we were the only ones in our CIIS groups who actively practiced with KAP. And that I was the only board-certified psychiatrist in both of my groups. That surprised me. It also clarified something - there just aren't that many psychiatrists who've done the clinical training AND have years of prescribing experience AND also do therapy. They're out there. But the roles are usually split across three different people.
I'm also honest about the limits of what we know. To a fault, sometimes. The psychedelic field is changing fast, and the science hasn't caught up to the enthusiasm. I'm not going to tell someone that daily microdosing is safe long-term: we don't have the data. I'm not going to promise a ketamine journey will be transformative. I don't do transformation language, though it sells. What I do is bring the same rigor, care, and nuance to this that I bring to any clinical decision - what does the evidence actually say, what are the risks, what makes sense for this specific person.
The fragmentation problem
It's often the case that someone will have a therapist, a prescriber, and maybe a ketamine clinic. They may not talk to each other or they're busy, and the systems make it hard. The prescriber doesn't know about the ketamine. The ketamine clinic doesn't know about the trauma history. The therapist is doing beautiful work but doesn't have the medical training to think about drug interactions. This isn't necessarily always bad and in fact, sometimes dividing it into teamwork is the best approach.
I often work in a model where all of that lives together. One relationship. One person who can think about the medication, do the therapy, understand the psychedelic experiences, and hold the whole clinical picture. It takes more time. It doesn't scale the way investor-backed clinics want things to scale. But I think it's what good psychiatric care can look like, especially in a moment where the treatment landscape is getting more complex, not less.
And in the moments where splitting it up actually does make the most sense (and I love that too), then I'm communicating with your other clinicians and taking care to play my part the best that I can.
What I actually offer
I offer ongoing general psychiatry (medications, supplements, lifestyle considerations) and therapy for adults throughout California. For my existing therapy patients, I sometimes incorporate low-dose ketamine with brainspotting when the relationship and the clinical moment call for it. For a small number of therapists I trust highly, I prescribe oral ketamine lozenges for their clients' sessions, carefully, in small batches, with my own evaluation and ongoing involvement.
I'm also involved in intimate group ketamine experiences in San Francisco: up to six people, proper medical screening, with psychologists and psychiatrists present.
And for the people who aren't doing any of that but just want a psychiatrist who understands this world: who won't pathologize their curiosity, who can have a real conversation about what the research says and doesn't say, what the real risks, benefits, and medication considerations are. That's most of what I do, honestly. I'm a psychiatrist who also does therapy, who also happens to have trained deeply in psychedelic-informed care. The "friendly" part means I'm not going to make you feel weird about it.
Patricia Pop, MD is a board-certified psychiatrist in Half Moon Bay, California. She provides integrative telepsychiatry and psychotherapy for adults throughout California, combining evidence-based medication management with ongoing therapy and psychedelic-informed care.