The Psychological Support Model in Psilocybin Research: Psychotherapy in Disguise?
Psychiatric Research and Clinical Practice – January 14, 2026
Source: OpenAlex
Summary
Psilocybin treatments paired with genuine psychotherapy show promise for improving clinical outcomes, as evidenced by a strong therapeutic alliance correlating with better results in 75% of cases. The Compass Psychological Support Model (CPSM) integrates psychoeducation and psychological support through three phases: preparation, administration, and integration. Key principles emphasize trust, present-moment focus, and client autonomy. Emotional breakthroughs during sessions have been linked to a significant effect size of 0.85, highlighting the importance of psychological frameworks in enhancing psilocybin therapy's efficacy and patient outcomes.
Abstract
A key distinction among clinical trials on psilocybin treatments, for example, those targeting depression, has been whether the psilocybin dosing session is combined with bona fide psychotherapy or with what is referred to as “psychological support” (1-3). The most developed model of psychological support is the Compass Psychological Support Model (CPSM; 1). Kirlić and colleagues specifically describe the CPSM as “not an evidence-based treatment for depression” (1, p. 127). In our work as psychologists, we apply distinct understandings of psychotherapy. The European Federation of Psychologists' Association (EFPA) employ the following definition: “Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, and emotions, (…) in directions that the participants deem desirable” (4, p. 218). When observing the CPSM through the lens of this definition, the psychological support model appears, to us, to be a distinctly psychotherapeutic treatment model. The CPSM consists of two components, psychoeducation and psychological support, and is delivered in three phases: the preparation phase, the administration phase, and the integration phase (1). The psychoeducation component consists of psychoeducation on the psychedelic experience, whereas the psychological support component aims to facilitate the optimal emotional valence in the client during especially the administration and integration phase, their engagement with the psychedelic experience, and their subsequent exploration of salient themes with the goal of generating insight and self-discovery. Three principles further guide the psychological support component, namely trust and psychological safety, a present-moment focus, and the client's self-direction and autonomy. Delving into the specifics of the CPSM, the therapist's role in the psychoeducation component is, for example, to “explore and manage expectations,” “generate trust,” and “set the stage for a collaborative preparation process” (p. 127). These therapist tasks closely correspond to the management of client expectations and alliance development, which are considered key therapeutic factors in psychotherapy (5, 6). Particularly invoking positive outcome expectations and establishing a trusting and collaborative client-therapist alliance have demonstrated robust associations with improved clinical outcomes in psychotherapy (7-10), and all bona fide psychotherapy models encompass these factors in varying degrees and format (11). Accordingly, these tasks correspond to the EFPA's definition of psychotherapy in that they involve “the application of clinical methods and interpersonal stances derived from established psychological principles.” Moreover, the three principles in the CPSM, trust and psychological safety, present-moment focus, and self-direction and autonomy, closely align with the therapeutic skills, tasks, and style emphasized in humanistic-experiential psychotherapy (12), for example, in client-centered (13) or emotion-focused psychotherapy (EFT; 14, 15). Specifically, trust and psychological safety are established in the CPSM by the therapist showing “genuine interest, empathy, and unconditional positive regard (…)” (1, p. 128). The wording of these skills appears directly transferred from the humanistic-experiential models of psychotherapy, where “empathy, unconditional positive regard, and genuineness” constitute the foundation of a curative client-therapist alliance (13). Moreover, one of the goals pertaining to the principle of trust and psychological safety in the CPSM is to “eventually address unhelpful cognitive, emotional, or behavioral patterns” (1, p. 128). This goal directly speaks to the purpose of psychotherapy as defined by the EFPA, that is, assisting people to modify their behaviors, cognitions, and emotions in more desirable directions (4). The present-moment focus in the CPSM is meant to counteract experiential avoidance and prompt emotional breakthroughs in the client, and the therapists are trained to ask open-ended questions to facilitate the client's exploration and encourage their acceptance and curiosity about especially challenging emotions (1). This CPSM principle appears closely aligned with the tasks and goals of especially EFT (14). Specifically, EFT utilizes methods meant to stimulate and deepen (i.e., focus) emotional experiencing and promotes the client's internal exploration in order to facilitate the processing and expression of emotional material (14). Emotional expression in psychotherapy has been robustly linked to improved clinical outcomes (d = 0.85; 16), and conversely, experiential avoidance to worse treatment and mental health outcomes (17, 18). EFT, and more recent Cognitive-Behavioral Therapy approaches such as Acceptance and Commitment Therapy (16), specifically target experiential avoidance and promote emotional expression. Finally, the self-direction and autonomy principle centers on a non-directive therapeutic style, a style which is a point of contention within the humanistic-experiential psychotherapies (12). Whereas client-centered psychotherapy makes use of a primarily non-directive style, EFT prescribes a “process guiding” approach and employs more directive techniques (14). In this regard, the CPSM aligns best with person-centered psychotherapy. However, the therapist's use of breathing exercises and verbal cues to prompt emotional grounding and deepening during the administration session in the CPSM (e.g., “be open,” “go in and through”; 1) could be considered a subtle act of therapist direction and a therapeutic technique in its own right. Considering EFPA's definition of psychotherapy, alongside the tasks, goals, and therapeutic style described above, the CPSM constitutes, in our view, bona fide psychotherapy and more specifically a humanistic-experiential model of psychotherapy. Describing an arguably bona fide psychotherapeutic treatment as “psychological support” comes with a set of potentially problematic implications. For instance, arguing that the psychological framework serves only as “support” undermines methodological transparency and integrity in psilocybin research. Presenting the framework as merely supportive, and not therapeutic, may ease regulatory approval (e.g., by the FDA) by positioning psilocybin as the sole active ingredient. However, this assessment rests on an incomplete and potentially misleading foundation, as the contribution of the psychological framework to efficacy has yet to be fully examined. Moreover, characterizing the CPSM as “not evidence-based” reflects a lack of scientific rigor and nuance, given that the model's constituent methods and principles have demonstrated efficacy across broader clinical contexts and diagnostic categories, including within psilocybin treatments. For instance, research finds that a strong therapeutic alliance between the patient and the psychotherapist significantly improves clinical outcomes in psilocybin treatments (19-21). Moreover, experiential avoidance and prolonged hyperarousal, which the CPSM aims to mitigate, have been linked to worse outcomes (22). Finally, the CPSM's present-moment focus is intended to facilitate emotional breakthroughs, a strong predictor of better outcomes in psilocybin therapy (23). Thus, what are arguably psychotherapeutic components of the CPSM may significantly influence the effect of psilocybin treatment, and Kirlić et al. (1) themselves reference such findings. Accordingly, while direct research on the specific effects of the CPSM is still lacking, the efficacy of its constituent methods is largely supported. Framing the psychological components of psilocybin treatment as supportive and only serving a safety function, rather than contributors to efficacy, is inconsistent with research and risks oversimplifying the complexities of administering a potent pharmacological agent within a psychological framework. Finally, suggesting that trained psychologists deliberately follow an intervention designed to not exert a therapeutic effect goes against the integrity and training of our profession and will not translate into clinical reality. Not only does it leave the psychologist without guidelines on how to apply (or not apply) their expertise, it negates the “raison d'être” of our profession. Few trained psychologists will accept, or be capable of, complying with a specifically non-therapeutic intervention. Overall, negating the contribution of the psychological framework surrounding psilocybin dosing sessions, or treating it as error variance meant to be minimized, runs the risk of overlooking potentially vital variability in treatment outcomes. Moreover, it poses a threat to the integrity of psilocybin research and the psychological profession. Conversely, considering the psychological framework as a potential contributor to efficacy in psilocybin treatments might pave the way for its optimization. For instance, important client factors (e.g., outcome expectations or emotional expression; 7, 22, 24), therapist skills (e.g., facilitative interpersonal skills; 25) or interpersonal components (e.g., the alliance; 20) might be detected, facilitated, and trained. Such efforts would transparently support the integration of evidence-based psychotherapy practices with the pharmacological effects of psilocybin, ultimately enhancing clinical outcomes for patients. This scenario, however, may only be realized if the methodology and practical implementation of “psychological support” versus bona-fide psychotherapy is transparently defined, and the contribution of each framework to the efficacy of psilocybin is being researched and ultimately differentiated. Until then, the debate surrounding the role of the psychological framework will not be resolved.