This article was originally published on Psychedelic projector and appears here with permission.
A recent study asks 23 underground psychedelic therapy practitioners about the biggest ethical issues and boundary challenges they face while sharing such an intimate space with clients.
Psychedelic therapy clinical trials are extremely promising in the fight against mental health problems. However, recent research has shown that there are a myriad of ethical issues associated with the therapeutic use of psychedelics.
One of the most important, and potentially widespread, issues identified in a study published in the Journal of Humanistic Psychology involves sexual abuse between psychedelic therapists and clients. The researchers of this article hope to shed light on ways in which these cases can be prevented as psychedelic therapy becomes mainstream.
Vulnerability and power
Psychedelic therapy itself, whether assisted by MDMA or psilocybin, leads us into fragmented ethical territory. There is a huge power imbalance between therapist and client during psychedelic sessions; patients already have mental health problems, which are associated with the often incapacitating effects of a high dose of a psychedelic.
This has led some psychedelic therapists to exploit the vulnerability of their patients. There have been reports of sexual abuse in psychedelic therapy as recently as 2018, in an FDA Phase III MDMA trial for PTSD.
These problems are not isolated from psychedelic therapy. Cases of sexual abuse are shockingly high in traditional talk therapy (around 7-12%). But it begs the question: if cases are this high in traditional therapies, how high could they be if and when psychedelic therapies become mainstream? And how can these cases of sexual abuse be prevented?
This is the question on the lips of the authors of this article. In an attempt to answer this question, the researchers interviewed 23 underground psychedelic therapists. Authors and therapists have explored how ethical issues can arise in psychedelic therapy and ways to prevent them.
When interviewed, some therapists pointed out that long sessions, coupled with the therapeutic use of touch, can lead to a level of intimacy not seen in conventional talk therapy. The authors write: âMany [therapists] felt that this intimacy is part of what is therapeutic in psychedelic work. However, they noted that it also led to ethical boundary issues, often inadvertently fostering romantic feelings in the client. “
It can also be doubly difficult during MDMA-assisted therapy. The effects of MDMA can include increased empathy, sexual arousal, and increased intimacy, which can further blur the lines for a patient during the session. Again, this highlights the extreme vulnerability of the patient, who must always be at the forefront of a therapist’s mind.
One of the main prevention issues around psychedelic therapy was related to consent. One of the therapists discussed their two-step consent process surrounding touching: âIn advance, even before entering the experiential session, I ask, ‘Can I work with your body or touch you â. Otherwise, I won’t touch them. Even if they said yes, during the trip itself, I will ask them first, “May I put my hand on your shoulder, your chest, your belly?” ”
Other therapists have emphasized the need for supervision when conducting psychedelic therapy. Having two therapists, a man and a woman, should be a benchmark practice in psychedelic therapy and hopefully prevent so many sexual transgressions from occurring.
Psychedelic therapy Moving forward
The emerging profession is, without a doubt, a minefield.
The power imbalance between therapist and patient is already huge and only gets worse when psychedelics are involved. The authors of the article highlight this by claiming that psychedelic therapy is “filled with unique ethical challenges that require self-awareness and practical approaches that go beyond training a conventional psychologist.”
However, this research is a step in the right direction. Hopefully organizations take up this research and form stricter guidelines for psychedelic practitioners.