Over the years, several high-profile examples of psychedelic therapy abuse have made the national news—in some cases, prompting concerns about the safety of the treatment, especially when it comes to the patient-therapist relationship.
Because psychedelics put you in an altered state, it’s particularly important to have structure and professional guidelines in place to ensure your safety while you receive treatment. However, as of now, those guidelines are still nebulous—largely because psychedelic therapy is still illegal in most states.
As psychedelic therapy becomes legal, professional guidelines will come. In the meantime, here’s what you need to know about the risk of psychedelic therapy abuse, as well as how to choose a reputable psychedelic retreat and establish a safe relationship with your practitioner.
Keep in mind that psychedelics are currently illegal in the United States, and that possessing or using them could lead to legal trouble. This article is for informational purposes only and does not encourage illegal drug use.
What Is Psychedelic Therapy Abuse? Ethical Guidelines for Therapists
The same guidelines for standard therapy apply to psychedelic therapy. As a patient, you deserve safe, professional conduct from your therapist or practitioner. Severe breaches of that ethical conduct constitute therapy abuse.
In the United States, licensed therapists and psychologists are bound by the American Psychological Association (APA) code of ethics, which includes, among other principles:1
- Avoiding personal relationships with patients. This includes sexual or romantic relationships, as well as friendships outside of treatment, digital relationships like engaging on social media, and any other contact that is not in direct service of the patient’s treatment.
- Avoiding exploitative relationships. Therapists do not engage in exploitation of patients. This includes avoiding sexual relationships with current or former patients (as well as relatives or friends of patients), never bartering for therapy or taking financial advantage of patients, and not demanding things from a patient that are not in direct service to the patient’s best interests and wellbeing.
- Avoiding multiple relationships. A patient and therapist should limit their relationship to professional interaction. For example, your friend, boss, family member, partner’s friend, etc. should not take you on as a therapy client.
- Working in the patient’s best interest. A therapist should avoid putting personal interests above a patient’s wellbeing.
- Avoiding harm. A therapist should take reasonable steps to avoid harming patients, and to minimize harm when it is unavoidable or forseeable.
- Avoiding mind-altering substances in the presence of patients. This is particularly relevant to psychedelics—during your sessions, your therapist should not partake in the psychedelic drugs you are taking.
If you’d like, you can read the APA code of ethics in its entirety. These professional standards apply to psychedelic therapy treatment and should be upheld at all times.
Any breach of these guidelines is grounds for firing your therapist, and severe breaches may be considered therapist abuse.
Special Ethical Concerns in Psychedelic Therapy
The introduction of psychedelics raises specific ethical questions in therapy. A few notable ones are:
Consent to physical touch
Physical touch can be tremendously healing in a therapeutic context, and some therapists have argued that banning touch outright in psychedelic therapy would actually be doing harm to patients.
However, a patient under the influence of a mind-altering drug requires a much higher standard for consent. This is particularly true of psychedelics, which may make you more suggestible to accept and act on the requests of others.2
One approach is to lay out clear boundaries for touch with your therapist before each session. For example, you might choose to consent to a supportive hand on the shoulder, but not an embrace. During the session, your therapist should use professional judgment.
Sexual and romantic relationships
Any touching of a sexual nature is unacceptable in any therapeutic context, and is clear-cut abuse. Therapists who engage in romantic or sexual behavior with patients, current or former, are at risk for losing their license.
It’s particularly important to enforce this boundary during psychedelic therapy. MDMA, for example, often increases sexual behavior and desire, and patients in an MDMA-assisted psychotherapy session may make sexual advances toward therapists, or be more receptive to sexual advances from others.
It is essential that no sexual or romantic interaction occurs in these contexts. It’s the job of the therapist to maintain this professional boundary, even if a patient appears willing or makes sexual or romantic advances while under the influence of a mind-altering drug.
Sobriety on the part of the therapist
A therapist should not be under the influence of drugs or alcohol while treating a patient. This includes psychedelic drugs.
Your therapist should never take a drug with you during a therapy session. Doing so compromises the therapist’s professional judgment, and is a breach of ethics.
Avoid any therapists or practitioners who offer or encourage co-consumption of psychedelics during sessions.
Trust is essential in any therapeutic relationship, but it’s particularly important when a patient is doing psychedelic-assisted therapy.
Psychedelics put patients in a vulnerable state. A patient needs care and guidance while under the influence of a psychedelic drug, and is unable to function normally until the experience is over.
Reputable therapists understand this and work to establish trust and rapport with patients prior to giving them psychedelic drugs. In most cases, psychedelics are only a small part of an overall therapy plan, and therapists usually have at least one (and often several) sober therapy sessions with patients before doing psychedelic-assisted psychotherapy.
Be sure you trust and are comfortable with your therapist before taking a psychedelic in the therapist’s presence, and look for someone who seeks to establish that trust and comfort with you.
How to Avoid Psychedelic Therapy Abuse
While therapist abuse is rare, it does happen. Unfortunately, until psychedelics are legalized and a formal code of ethics is formed, avoiding psychedelic therapy abuse falls on the good judgment of the patient.
When choosing a practitioner, consider the following safe practices:
- Meet the practitioner beforehand. At a minimum, have a conversation and, ideally, a sober therapy session together. Make sure you trust the person giving you therapy before accepting any psychedelic drugs.
- Establish clear guidelines for physical touch. Have a conversation with your therapist about boundaries for touch during sessions. A good therapist will agree to those boundaries and maintain them during your sessions.
- Be aware of your practitioner’s sobriety. Avoid any practitioner who proposes taking psychedelics together. Your therapist should be sober during your therapy sessions. Note that there may be exceptions for certain longstanding cultural rituals, such as Ayahuasca ceremonies. In such cases, it may be traditional for the person leading the ritual to partake of the drug, and ritual attendees should be informed.
- Look for licensing, referrals, or reviews. Ideally, you’ll be able to find licensing information about your therapist online. For traditional ceremonies like Ayahuasca, many ritual leaders share their shamanic lineage, which is a similar marker of competence. If someone referred you to the practitioner, reach out and ask about that person’s experience. Alternatively, look for reviews or descriptions of the practice online. When possible, do research to get a better sense of how your practitioner operates, and whether people have had good experiences with the therapy in the past.
- Choose safe retreats. It’s particularly important to verify psychedelic retreats as best you can. Our guide to choosing a reputable Ayahuasca retreat can help you vet potential options.
Keep in mind that, unless you’re taking part in an approved clinical trial or doing psychedelic-assisted therapy in a state in which it’s legal, you likely do not have an established route to report abuse.
Additionally, if you take psychedelics illegally and are abused by a practitioner, going to the police may put you at personal legal risk. This is an important factor to consider when deciding whether you want to pursue psychedelic-assisted therapy illegally.
If you decide to do psychedelic therapy, it’s important to know your rights as a patient, as well as what constitutes safe and appropriate behavior on the part of your therapist or practitioner.
In time, hopefully the above guidelines will be formalized into a legally enforced code of ethics. For now, staying safe during psychedelic treatment falls largely on the shoulders of the patient.
Take as much care as you can to make sure you trust your practitioner or the institute providing psychedelic therapy. Consider reading the APA’s code of ethics to better understand what healthy treatment boundaries look like, establish a relationship with your practitioner before doing psychedelic therapy, and always remember that you can leave if anything feels dangerous or inappropriate.
Finally, keep in mind that psychedelics are currently federally illegal in the United States, and that taking them comes with legal risk.
1. American Psychological Association. Ethical Principles of Psychologists and Code of Conduct. American Psychologist. 2017;57(12):1060-1073. doi:10.1037//0003-066X.57.12.1060
2.2. Carhart-Harris RL, Kaelen M, Whalley MG, Bolstridge M, Feilding A, Nutt DJ. LSD enhances suggestibility in healthy volunteers. Psychopharmacology (Berl). 2015;232(4):785-794. doi:10.1007/s00213-014-3714-z