A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing

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.

Study at a glance

Abstract

As both 3,4-methylenedioxymethamphetamine (MDMA)- and psilocybin-assisted psychedelic psychotherapy near U.S. Food and Drug Administration (FDA) approval and gain acceptance as efficacious clinical approaches, concerns have been raised about the likelihood of sexual violation of a client and other relational boundary transgressions. In the current study, 23 practitioners who have administered MDMA and psilocybin to clients in underground (i.e., extralegal) healing contexts were interviewed about their experiences navigating multiple relationships, nonsexual touch, and sexual boundary-setting in their work. Of these practitioners, 12 had undergone formal, graduate-level training in psychotherapy, 10 identified as female, and 13 identified as male. A phenomenological research design was used to assess what unique relational challenges they have faced in this work and what practices they have found helpful in doing so. Two sets of themes addressing these two questions were developed from the data. Descriptive themes represent the unique challenges that psychedelic practitioners have encountered in their work, and prescriptive themes are made up of the practices they have found most useful in confronting these challenges. Some themes are unique to psychedelic work (e.g., client nudity, the use of touch, the belief that therapists must continue to have their own psychedelic experiences), while others represent a psychedelic-specific take on standard ethical considerations (e.g., transference, supervision, staying within one’s scope of competence). Discussion of these results includes implications for the training of psychedelic psychotherapists and other regulatory decisions facing the field. Editor’s Note The manuscript “A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing” by Brennan et al. presents a descriptive psychological study of ethical challenges faced by “underground” practitioners of psychedelic healing approaches. The manuscript is a descriptive study of the healers’ subjective experiences and related ethical challenges; its purpose is not to validate or normalize these underground practices. Importantly, some practices of underground practitioners are explicitly disallowed by ethical guidelines in the mental health professions. Licensed psychologists and other mental health professionals should abide by the ethical codes and guidelines for research and practice in their relevant professions, including but not limited to the Ethical Principles of Psychologists and Code of Conduct ( https://www.apa.org/ethics/code ), the American Counseling Association Code of Ethics ( https://www.counseling.org/docs/default-source/defaultdocument-library/ethics/2014-aca-code-of-ethics.pdf ), and the American Medical Association Code of Medical Ethics ( https://code-medical-ethics.ama-assn.org/principles ). Please see the addendum to this article for more information.