Psychedelic-assisted therapy makes patients highly suggestible and sensitive to context by increasing the influence of bottom-up input, which can revise rigid beliefs. This heightened vulnerability, where patients lose control and become dependent on the therapeutic setting, raises ethical concerns. Some therapists have exploited this vulnerability in the past. To ensure valid informed consent, patients must be well informed about these mechanisms and their implications. Additional security measures are needed to protect patients in current research and future mainstream medical settings.
Ethical problems in training for psychedelic therapy include the need for comprehensive training due to participant vulnerability, reliance on psychedelic experience without psychotherapeutic training, self-disclosure of personal psychedelic use, and guruism. Mitigation strategies include ethics codes and training, monitoring and control via video recording, requiring professional licensure and psychotherapy training for practitioners, and imposing a cooling-off period after therapists' personal psychedelic experiences to avoid a 'honeymoon' effect.