While the basic model of psychedelic-assisted therapy, including preparation, dosing, and integration sessions, has been established for a variety of substances and treatment conditions, growth continues in how psychotherapy can best support psychedelic experiences. Psychedelics are highly susceptible to set and setting, and there is consensus that what clinicians do before, during, and after psychedelic experiences is important in achieving therapeutic outcomes. This poses several questions: Given limited time and resources, what are the best psychotherapy approaches that will result in maximal results? How do we train a broad group of clinicians from various theoretical backgrounds to conduct psychedelic-assisted therapy in a way that minimizes burden and cost?

To date, psychedelic-assisted therapy research has included a diversity of therapy models including psychodynamic, cognitive-behavioral therapy, acceptance and commitment therapy, motivational interviewing, transpersonal, Jungian, and more atheoretical or eclectic approaches. Some advocate for greater inclusion of more evidence-based approaches which have often been left out of psychedelic clinical trials (Greń et al., 2024). Traditional psychotherapy methods, however, may not be adequate to address the unique complexities of working with psychedelic experiences. This book and the EMBARK model describe an approach to psychedelic-assisted therapy for the treatment of depression that attempts to meet this need and balance the integration of our best evidence-based therapies with a more flexible approach to address the wide variety of clinical situations that can arise during psychedelic-assisted therapy.

Although EMBARK was originally developed by Cybin, a biopharmaceutical company developing psychedelic treatments, within the context of a clinical research trial of psilocybin for depression, this book is broadly applicable to a range of psychedelic substances and mental health care conditions. The authors, Bill Brennan and Alex Belser, bring a depth of experience from working in the fields of psychedelic-assisted therapy, psychotherapy, and clinical research. The tone of the book exhibits a sense of humility and respect for prior research and psychedelic leaders, as well as the desire to collaborate with others in continuing to advance the field of psychedelic-assisted therapy. The EMBARK model even offers an open-access course available on their website.

Brennan and Belser begin by summarizing prior psychedelic-assisted therapy models and identifying their shortcomings, such as lack of attention to the body, insufficient focus on ethics, and limited conceptualization of change mechanisms. They then introduce EMBARK, which includes six clinical domains, each meant to capture a common aspect of psychedelic-assisted therapy: Existential-Spiritual, Mindfulness, Body-Aware, Affective-Cognitive, Relational, and Keeping Momentum. These domains were chosen after a literature review of prior therapy models from rigorously controlled clinical trials within the last 20 years. Brennan and Belser aimed to develop a succinct and practical set of domains that could capture the broadest spectrum of facets in psychedelic-assisted therapy. EMBARK culminates in a generalizable and cohesive model with an eye towards feasibility and efficiently training clinicians who come from a wide variety of backgrounds and theoretical orientations. The six clinical domains are also meant to be flexibly applied to each individual, as clients may differ in terms of how relevant each domain is to their psychedelic experience and therapeutic process.

For example, the Body-Aware domain in EMBARK addresses an often-overlooked aspect of psychedelic-assisted therapy: embodied phenomena. Brennan and Belser highlight that while Western psychiatry typically focuses on the mind, subjective reports from PAT participants indicate that bodily experiences often play a vital role in their healing process. These experiences can range from sensations of bodily energy flow to re-negotiations of one's relationship with their body. This domain encourages a receptive approach to these bodily experiences, emphasizing “listening to the wisdom of the body” rather than rushing to cognitive interpretation. This approach aims to integrate these important physical aspects into the overall therapeutic process, potentially unlocking new avenues for healing and self-understanding.

Another frequently ignored element in prior PAT models is the relationship between the participant and the therapist, which is addressed via the Relational domain of EMBARK. During dosing sessions, individuals often choose to engage with the therapist in significant ways that may lead to experiences relevant to external relationships and their current treatment goals, such as experiences of increased trust or an increased desire to repair relationships with loved ones. Ethical and competent exploration of the therapeutic relationship can lead to positive outcomes, though the authors also caution about the magnified potential for harm in a psychedelic state, such as increased risk for boundary transgressions. The authors stress that the therapist's mere presence can hold significant relational meaning for the participant. EMBARK's Relational domain encompasses all aspects of how relationships, both inside and outside the therapeutic context, can contribute to the healing process in psychedelic-assisted therapy.

EMBARK recognizes that the true value of psychedelic insights and experiences lies in their continuous integration outside the therapy room, which is addressed in the Keeping Momentum domain. New behavioral patterns, relationships with thoughts and feelings, and changes to the sense of self or self-perspective often arise during psychedelic sessions, though sustaining such benefits through intentional effort, supported by therapists, is often what is needed for lasting change to occur. This domain also deals with relapse prevention. With enough momentum, individuals can experience setbacks without fully relapsing into depression or whatever mental health condition they are struggling with.

The development of EMBARK centers on four ethical care cornerstones: Trauma-informed care, culturally competent care, ethically rigorous care, and collective care. These four cornerstones are meant to improve upon earlier models which often neglected or minimized the importance of attending to such ethical issues. Each cornerstone functions to draw clinicians' attention towards certain fundamentals of ethical practice as it pertains to unique issues in psychedelic-assisted therapy. For example, the importance of applying a trauma-informed lens is emphasized due to the common occurrence of resurfaced trauma memories that occur in psychedelic experiences, even when trauma is not necessarily the focus of treatment. The four cornerstones can also help clinicians be more cognizant of the potential for abuse due to the magnified power disparity and complicated issues around consent (e.g. the use of therapeutic touch) that are associated with psychedelic experiences. Taken with the six clinical domains, the authors term this structure the “6 + 4.”

Once the authors have described the structure and core tenants of EMBARK, they walk through every step of psychedelic-assisted therapy from the time before meeting a participant to the final moments of the practitioner's relationship with them. Preparation, medicine, and integration sessions are each described through the lens of EMBARK's clinical domains and care cornerstones, helping to clarify the utility of each. The authors consider possible situations and challenges at each stage of treatment and provide specific, thoughtful guidance from which to take inspiration. While they do provide in-depth advice, they also leave room for experienced practitioner's clinical judgment to guide treatment. This makes the model more flexible and approachable to those newer to psychedelic experiences.

This book is an excellent introduction to psychedelic-assisted therapy for newer clinicians, but also contains a wealth of detail that applies to anyone already practicing in this field. The inclusion of client quotes from their experiences in psychedelic-assisted therapy provides helpful context for understanding many of the common clinical situations that may arise. EMBARK is a newer model that would benefit from further empirical testing but represents a skillful attempt to balance the merits of evidence-based practice with the unique features of psychedelics. Brennan and Belser provide strong arguments for each component of the EMBARK model and emphasize that each domain may or may not be relevant for each individual client. They are successful at providing a practical framework that can be approached from a variety of therapist backgrounds and applied to a variety of clinical indications and psychedelic substances. With a firm ethical foundation, they also set an exemplary standard for future clinical trials investigating psychedelics.

This book is written with the highest degree of scholarship and represents a significant step forward for the field of psychedelic-assisted therapy. EMBARK serves as evidence for the importance of psychotherapy in maximizing clinical benefits in psychedelic-assisted therapy, especially in the context of current systemic forces that might devalue the role of therapy. EMBARK offers a practical, trainable, and broadly applicable approach that can help inform future clinical trials and support the role of therapists in preparing, facilitating, and integrating psychedelic experiences.