Somewhere around the end of your session, a client mentions the capsules a friend gave them. They take them on Mondays and Thursdays, and they feel better than they have in years. If you’re a therapist, you probably know the feeling that follows: a quick, quiet rush of questions you weren’t trained to answer.
This guide is for that moment. It won’t make you a microdosing expert, and it isn’t meant to. It’s meant to help you respond with curiosity, understand this doesn’t have to be a scary topic, stay inside your scope, and keep your client talking to you.
Microdosing is already in your caseload
Microdosing has moved from the margins into everyday conversation. In Colorado, the Natural Medicine Health Act decriminalized personal possession and use of psilocybin (and mescaline, which is becoming more popular as a microdosing medicine) for adults 21 and over in 2022, and clients across the country are experimenting on their own whether or not their therapist knows. Many are high-functioning adults managing depression, anxiety, burnout, or trauma who have already tried medication and talk therapy and are looking for something more.
The clinical risk usually isn’t that a client microdoses. It’s that they microdose and stop telling you about it.
Why clients don’t tell you
Many clients assume their therapist won’t approve, won’t understand, or will refer them out or end the work. Others worry about what goes in their record, or tried bringing it up once and felt the conversation shut down. In online communities, the advice they get is often “just do it and tell them later,” or “skip the therapist and find a coach.” Right now, many people simply don’t trust therapists with this information. If we want clients to bring it into session, they need a clear sign that it’s safe to.
Lead with curiosity, not a verdict
Your first response sets the tone for every disclosure after it. A client who feels judged will simply stop bringing it up. A client who feels met will keep you in the loop, which is where you can actually be helpful.
You don’t need to approve or disapprove. You need to understand what’s happening, assess risk, and stay connected. “Thank you for telling me. Can you walk me through what that looks like for you?” goes a long way.
Four questions to start with
1. What are you taking, and how often? Ask about the substance, where it comes from, and the schedule. You aren’t advising on any of this. You’re gathering the same information you’d want about any substance a client mentions.
2. What else are you taking? Ask about every medication, supplement, and other substance your client ingests. Some combinations carry real risk. Lithium, for example, has been linked in case reports to seizures when combined with classic psychedelics, and serotonergic medications may change how a client responds. This is where a prescriber often belongs in the conversation.
3. What are you hoping it does? Intentions tell you a lot. “I want to feel less numb” and “I’m trying to get off my antidepressant without telling my doctor” lead to very different clinical conversations.
4. How will we know if it’s helping? Invite tracking. Sleep, mood, energy, focus, and, for clients with a menstrual cycle, cycle phase. Tracking turns vague impressions into something you can work with together. (If your client wants a starting point, our cycle-aware microdosing journal includes a free tracker.
Where your scope ends
Supporting a client’s self-directed use is different from administering a substance, sourcing it, recommending a dose, or being present during dosing. Supporting looks like assessment, psychoeducation, harm reduction, risk monitoring, integration of what comes up, and referral when needed. Those are things you already know how to do.
In Colorado, administering natural medicine is a separate licensed role under the Natural Medicine Health Act. Outside Colorado, the legal picture is different again. If you’re unsure where your line is, consult your licensing board’s guidance and your liability carrier.
When to bring in a prescriber
Involve a prescriber when your client takes psychiatric medication, has a history of bipolar disorder or psychosis, or shows signs of mood destabilization. Encourage the client to have that conversation themselves when possible, and never suggest stopping or changing medication on their own. If a client declines, document the conversation and your recommendation.
Documenting it honestly
Chart what the client reports, your assessment, the risks you discussed, and any referrals or recommendations. Keep it factual and avoid speculating beyond what was said. Clear, prudent documentation protects both you and your client, and it makes it easier to see patterns over time.
Why I believe you should know this from the inside
Here’s my opinion, and you’re welcome to take what resonates. I believe clinicians who support clients who microdose benefit from their own lived relationship with the practice, not just a certificate. Knowing what week six can feel like changes the questions you ask and the reassurance you can offer. It isn’t the only path, and it isn’t required to be a good therapist, but it has shaped every part of how I do this work.
Where to go from here
If you’d like a practical reference to keep on hand, download the free clinician guide, Supporting a Client Who Microdoses, on the CMIT page.
If you want real depth and confidence to do this work, Cohort 1 of the Clinical Microdosing Integration Training begins in January 2027. It’s a 16-week certification for licensed mental health clinicians covering screening, medication interactions, documentation, ethics, and scope, with an optional 90-day personal protocol. The founding cohort rate of $2,450 is open through November 15, and there are six seats. Learn about the clinical microdosing training for therapists (link to CMIT page).
You might also find these helpful: Microdosing Coaching vs. Psilocybin Therapy and Should You Microdose or Macrodose?
This article is education for licensed clinicians and is not legal or medical advice. Psilocybin remains a Schedule I substance under federal law. Laws vary by state; consult your licensing board and legal counsel about your specific situation.
