Practitioners who have administered MDMA and psilocybin in underground (extralegal) healing contexts face unique relational ethical challenges, including client nudity, the use of touch, and the belief that therapists must continue their own psychedelic experiences. Interviews with 23 practitioners revealed descriptive themes of these challenges and prescriptive themes of helpful practices. Some challenges are unique to psychedelic work, while others represent psychedelic-specific takes on standard ethical considerations like transference and supervision. The findings have implications for training psychedelic psychotherapists and regulatory decisions.
A systematic review of 33 published psychedelic clinical trials found that many reports inadequately describe the psychosocial interventions provided alongside the drugs. Over 80% did not report assessing treatment fidelity, more than half did not mention using a therapy manual, and nearly half omitted the duration or number of therapy sessions. This underreporting, worse than in non-psychedelic trials, undermines research standardization and the ability to understand how these interventions affect outcomes. The authors recommend improved reporting practices to clarify the role of psychological support in psychedelic treatment.
Chapter 1 introduces psychedelic-assisted therapy (PAT) and the EMBARK model, a new transdiagnostic and trans-drug approach adaptable to various conditions and psychedelic medicines. It critiques conventional PAT history for omitting harm and marginalized groups' stories. The chapter outlines common PAT elements: preparation, medicine, and integration phases; therapist dyads; set and setting; and the therapeutic container. It notes growing interest in psychedelic medicines for mental health disorders, especially depression, and mentions ongoing randomized clinical trials piloting EMBARK, plus a free open-access training program.