Bidirectional Case Transfers: Innovative Psychedelic Therapy Care
Learn how bidirectional case transfers (BCTs) can integrate traditional mental health care with psychedelic therapy providers and improve outcomes.
Medical Overview
Critical clinical insights are often lost in the gaps when it comes to mental health and medical care
Bidirectional case transfer (BCT) is a valuable tool that connects providers across a care team
Collaborative care deepens the therapeutic alliance
Bidirectional Case Transfers: A New Form of Care in Psychedelic Therapy
Psychedelics have entered the mainstream therapeutic conversation, and yet, use of these medicines remains hidden in many ways.
A survey of 1,435 people using psychedelics was taken, and it revealed that 72.5% had never discussed that use with their primary care provider. Close to half of this same sample (47.2%) reported using psychedelics to treat a medical condition or to work through trauma. But fewer than 5% of the people did so in a clinical or therapeutic setting.
People are trying to treat serious conditions with psychedelics, but they are often doing it outside the support systems built to safely treat and manage those conditions.
To solve this, we have designed a care system that we call bidirectional case transfer (BCT).
Bidirectional case transfer is a structured, two-way exchange of clinical information between a person's existing mental health practitioner and the team providing their psychedelic therapy. It’s a system of care where the practitioner is able to send historical information about their existing client before psychedelic therapy, and the psychedelic care team then returns a full overview of the therapeutic elements that transpired following the psychedelic session(s).
In this article, we'll look at what a BCT is, how it fits into mainstream psychotherapy, psychedelic disclosure issues amongst users, how missing patient information affects treatment, and how BCTs can enforce the therapeutic alliance in psychedelic therapy, therefore increasing outcomes.
What is a Bidirectional Case Transfer?
Case transfers occur when a patient moves from one provider to another within clinical practice. The sending provider transfers the case (patient history, treatments, information, etc.) over to the receiving provider so that the new provider has the correct knowledge about the patient to best help them.
BCT isn’t a one-way transfer, but instead, functions as a full loop to connect multiple professionals involved in a client’s care.
When utilizing a BCT within psychedelic therapy, information is exchanged between the two sides of professionals involved with a participant of psychedelic therapy:
- The participant’s existing primary mental health professional
- The therapy team providing psychedelic therapy to the participant.
Whether it’s a psychologist, psychiatrist, psychotherapist, or counselor, they can exchange information with the psychedelic care team through a BCT. This allows both sides of the participant’s care team to receive the information needed to provide the best care possible.
| Factor | With Bidirectional Case Transfer | Without Bidirectional Case Transfer |
|---|---|---|
| Mental health practitioner is involved in your psychedelic therapy process | Yes | No |
| Psychedelic care team receives a complete clinical picture from your provider | Yes | No |
| Your therapist receives all relevant information to best support your integration | Yes | No |
| Full therapeutic context available to both sides of your care | Yes | No |
| Traditional care and psychedelic care are linked | Yes | No |
| Direct contact between your therapist and psychedelic care team | Yes | No |
Before the psychedelic experience, the participant’s primary practitioner supplies clinical context to the team who will be administering psychedelic therapy. This includes client history, what has been tried, what has worked, progress, challenges, attitude towards the psychedelic treatment, and where the work currently sits.
After the experience, the psychedelic care team supplies a complete account of what took place during the sessions, including therapeutic themes, insights, breakthroughs, and other relevant details that emerged. Both exchanges require the client's written consent in the form of a Return of Information (ROI).
Introducing BCTs to better support clients of psychedelic therapy addresses numerous factors that all interact, including:
- Psychotherapy as a common mental health treatment amidst a mental health crisis
- The rise of psychedelic therapy to combat the mental health crisis
- A lack of disclosure regarding psychedelic usage with primary providers
- Widespread patterns of missing information in shared patient care
- The benefits of adequate collaboration between multiple providers administering client care
- The importance of cultivating the therapeutic alliance through shared effort between providers
The Prevalence, Duration, and Efficacy of Psychotherapy
Traditional mental health care typically involves interventions involving psychotherapy or psychiatric medication. Given the widespread mental health epidemic, this amounts to tens of millions of people in the United States alone. In 2022, 30 million people received treatment for the conditions they struggled with.
When it comes to psychotherapy, in 2024, 14% of Americans received some form of talk therapy within the last 12 months. This course of treatment can also be extensive in terms of the number of sessions and time duration that people receive psychotherapy.
The APA shares the following figures that reveal the long-term efforts:
- Research indicates that, on average, 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures.
- In practice, patients and therapists sometimes prefer to continue treatment over longer periods (e.g., 20 to 30 sessions over six months)
- Clinical research evidence suggests that people with co-occurring conditions or certain personality difficulties may require longer treatment (e.g., 12-18 months) for therapy to be effective.
Talk therapy is often a long-term process, and the relationship developed between therapist and client holds important information about the client’s history and progress.
Research also shows how psychotherapy yields varying outcomes. A 2024 paper reviewing the impact of psychotherapy on eight mental disorders showed that psychotherapy is effective for a wide range of conditions, and yet, the authors of the same study concluded, “most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.”
The kinds of people who seek new treatments, such as psilocybin therapy, are often the people who have been involved in long-term psychotherapy without finding the outcome they hope for, or have seen only modest improvements. People often choose psychedelic therapy after learning that it offers a different treatment approach than talk therapy.
What this means is that many people who engage in psychedelic therapy have a long history of psychotherapy or treatment with another provider, which presents certain issues that we will outline further below.
The Disclosure Gap Between Psychedelic Therapy and Traditional Mental Health Care
Whether people disclose the decision to try psychedelics to their mental health practitioner is showing to be a whole new issue. As psychedelic use becomes more common, this starts to present a real issue to the widespread convergence of psychotherapy and psychedelics.
In a survey of 1,221 adults who took psychedelics, only 22% disclosed this experience to their primary care provider and only 58% to their psychiatric provider. Participants listed stigma, inadequate provider knowledge, and legal concerns as the main reasons for not sharing this with them.
The different disclosure rates between primary care providers and psychiatrists vary because psychiatric consultation is often considered a necessity. People may be required to wean off existing medications to safely work with psychedelics. Medications are often one of the main contraindications with psychedelics.
The lack of disclosure with their primary care provider—often their therapist—shows how often psychotherapists are disconnected from their clients’ psychedelic experiences.
But how exactly does a practitioner learn anything specific about those psychedelic experiences? Typically, a client's own account of a psilocybin session is the only thing therapists have to work with, if the client chooses to even share the experience with them in the first place.
That means clients still in the midst of processing and understanding the experience are left to try to share everything their therapist should know about one of the most intense and complex psychological experiences a human being can have.
Which Resources Help Therapists Support Clients Who Try Psychedelic Therapy?
As psychedelic usage continues to rise, it’s becoming more important than ever that therapists are actually able to assist the clients who choose to partake in these experiences, recreationally or therapeutically.
Resources continue to be developed to better help clinicians support clients and patients who choose to use psychedelics.
Psychedelic Harm Reduction and Integration, for example, is a model to assist practitioners who are working with people who use or are considering taking psychedelics, without the practitioner administering anything.
MycoMeditations is also taking steps to best support these therapists by creating The Bridge™ to establish a system where important information regarding the client’s psychedelic therapy experience can be exchanged through bidirectional case transfers. Our position is that therapists equipped with better information can better support their clients.
Missing Information Between Patient Providers is a Widespread Problem
Disclosure and missing information for psychotherapists whose clients took psychedelics is common, as we’ve outlined above. Research at the University of British Columbia also found a similar pattern exists with physicians. Among 791 adults who use psychedelics, 80% reported therapeutic use, but only 30% of those had discussed it with their physician.
Outside psychedelics, the problem of information failing to travel between providers has already been observed and studied across numerous domains for decades.
Client Care Information Gaps Found in Physician Referrals
One study surveying primary care physicians and specialists at an academic medical center found that 68% of specialists received no information from the referring physician before the referral visit. Of those, 38% said the information would have been useful. Where the specialist did have prior communication, all of them reported having the information they needed. When there wasn’t earlier communication, only 57% reported having the necessary information.
A 2011 review reached a similar conclusion. It reported that many referrals carry no transfer of information in either direction, and that referring physicians often do not know whether the patient attended or what the specialist recommended. The authors also note that rigorous evaluation of the proposed fixes is still needed.
This idea of missing information between providers is considered a problem not just in America. In 2017, a French study of 434 private practice psychologists found that 64% felt unsatisfied with the collaboration between them and their client’s general practitioner (GP).
Communication Gaps Between Providers in Hospitals and the Patient’s Primary Physician
A systematic review in JAMA, which covered 55 observational studies involving communication deficits between hospital-based care and primary care physicians. This would involve patients who have a steady physician who received short-term care in the hospital.
This review found that direct communication between the two sets of physicians occurred in 3% to 20% of cases. A written summary was available at the first follow-up appointment in 12% to 34% of cases, rising to between 51% and 77% by four weeks. The gaps affected quality of care in roughly a quarter of follow-up visits.
The Problem of Missing Communication Between Mental Health Professionals
A survey of 53 psychotherapists reporting on 1,197 patients found that no communication had taken place with the prescribing clinician for 22% of the patients who were taking medication. Only 7 of the 53 respondents had quarterly contact with the prescriber across all their shared patients.
Split-care involving both a psychiatrist and psychotherapist is quite common, which necessitates the importance of communication between the providers. However, research shows that this communication doesn’t always happen.
A study in the Lancet found that, for patients receiving split-care for at least 6 months, the two providers offering treatment had zero communication for 23% of psychotherapy patients and 24% of psychiatrist patients.
If communication is missing between two mental health professionals working on the same patient for half a year, the prospects are even worse for practitioners in a newer discipline like psychedelic therapy whose only link is the patient.
Collaboration Between Providers Improves Outcomes
Collaborative care arrangements have providers responsible for the same patient work through a structured process of shared information. These have been examined in a review of depression and anxiety issues from 79 randomized trials covering 24,308 participants, which found significantly better outcomes all across short-, medium-, and long-term treatments.
Clients also experience different levels of satisfaction with treatment outcomes based on the level of communication (or the lack of it).
One study reviewed patients who received both psychotherapy and medication from separate providers. People knew whether their providers had communicated or not, and 30% reported that no communication took place. The findings showed that non-communication was associated with significantly lower satisfaction with treatment.
Therapeutic Alliance: Strongest Predictor of Treatment Outcomes
So why does all of this matter when it comes to information exchange and collaborative efforts of care? One answer is fairly obvious: everyone relies on information to do the best work possible.
Another layer, however, is the impact on the person who knows their wellbeing is taken into full account by everyone involved in helping them. This turns a conversation about trust and safety, which is important in its own way as we think again about psychedelics.
Decades of psychotherapy research have looked for the factors that determine whether treatment works. One factor that consistently stands out is the quality of the working relationship between the client and the person treating them.
According to Psychology Today, the therapeutic alliance is defined as: the strength of the relationship between a therapist and a client, defined by mutual trust, honest communication, and a feeling of safety within the confines of treatment.
A meta-analysis covering 295 studies and more than 30,000 patients found a reliable association between the strength of the therapeutic alliance and treatment outcome. These findings were consistent across treatment approaches, patient challenges, and nationality.
The Importance of the Therapeutic Alliance in Psilocybin Therapy
When we look at the impact that a strong therapeutic alliance and relationship between therapist and client has within this modality, we see similar conclusions as we do in psychotherapy.
Back in 2022, an analysis from Imperial College London assessed 30 people receiving two 25 mg doses of psilocybin for moderate to severe depression. Researchers measured the therapeutic alliance before each of the two dosing sessions and found that stronger alliances between therapist and participant were connected to greater emotional breakthrough and mystical-type experiences. This, in turn, was connected to greater decreases in depression. Additionally, a lower-scored therapeutic alliance involves weaker effects when it came to the psychedelic experience and outcomes.
A similar piece of research from 2024 also showed the same positive correlation between the strength of the therapeutic alliance and decreases in depression following psilocybin therapy. This study also showed that the correlation strengthened over the course of the treatment and was strongest at the final measurement during the last integration session of the intervention.
The relationship between therapist and client, enforced through numerous factors such as presence, chemistry, and feeling cared for, has a significant effect on the outcomes of the psychedelic therapy. This benefit is also shown to be capable of developing over time, further improving outcomes.
Bidirectional Case Transfer Can Enforce Therapeutic Alliance and Outcomes
Based on everything we strive for as a pioneering company within the psychedelic therapy space, we look to create a support system that helps close this gap between traditional care and psychedelic care. By making bidirectional case transfers available, we bring clients and each provider involved closer together through this exchange of information.
This BCT approach is designed to create a more integrated system of therapeutic care between clients, traditional care, and psychedelic care providers. This can help address many of the concerns and limitations raised in this article.
We pioneered this system because it strengthens the therapeutic alliance on both sides of mental health care for clients (traditional and psychedelic) by creating a supportive and collaborative method of therapy. As a result, this can lead to better outcomes for those who undergo psychedelic therapy with the help of a BCT.
Learn more about MycoMeditations’ bidirectional case transfer program, the Bridge, and apply for one of our retreats today.
Frequently Asked Questions About Bidirectional Case Transfer (BCT)
What is a bidirectional case transfer in psychedelic therapy?
It is a two-way exchange of clinical information between a client's existing mental health practitioner and the team providing their psychedelic therapy, with information exchanged before the retreat and after the session(s).
How is it different from therapist referrals for clients to try psychedelics therapy?
Referrals don’t involve any sort of exchange of information. If a therapist refers someone to psychedelic therapy, the therapist is making the suggestion because they believe it could benefit their client despite not being involved in the process themselves. A bidirectional case transfer introduces a system where actual information is exchanged between the therapist and the psychedelic therapy team. It includes the therapist within the process. Shared information allows both parties to better assist the shared client.
Does my therapist need experience with psychedelics to take part in the BCT?
No. Direct experience is always beneficial for the sake of understanding, but it’s not a requirement. The BCT helps us better understand your history and challenges with the help of your therapist, which helps us better support you on retreat. It also allows us to help your therapist best support you once you return home, whether they have experience with psychedelics or not.
Who can act as the practitioner in your bidirectional case transfer?
Therapists, psychologists, psychiatrists and coaches are all eligible, provided the client consents and the practitioner agrees to participate.
What does the practitioner receive back with a bidirectional case transfer?
With how we’ve designed our BCT, the practitioner receives a summary of the client’s retreat week. This includes notes from the introductory session, each of the three psilocybin therapy sessions, and the conclusion of the retreat. This is prepared by the retreat's lead therapist who shares details involving all the therapeutic elements that emerged during the psilocybin sessions and the themes worth continuing with in ongoing work between the client and practitioner.
