A NEW analysis of psychedelic-assisted psychotherapy (PAP) research calls for greater methodological rigor and ethical reflection as the field continues to evolve. The study highlights key gaps in current research, including the role of therapist-specific factors, the need for process-focused research, and the importance of expanding diversity in both clinical trials and therapeutic practice.
In recent years, interest in PAP has grown as clinical studies explore the therapeutic potential of psychedelics for treating psychiatric conditions. These treatments typically involve a combination of supervised psychedelic sessions and multiple psychotherapy sessions, both before and after dosing. However, the authors caution that the current body of research lacks sufficient exploration of therapist influences and therapeutic processes, which could have significant implications for patient outcomes.
While clinical trials have focused largely on therapeutic outcomes, little attention has been given to how the personal characteristics and experiences of therapists may affect those outcomes. Therapist-specific factors, such as their theoretical orientation, prior psychedelic experience, cultural background, and training, may implicitly shape the therapeutic process and influence patient expectations.
Given the heightened suggestibility associated with psychedelic experiences, how therapists frame these experiences may profoundly impact outcomes. For instance, presenting psychedelics as a means for spiritual insight versus a tool for enhancing psychological flexibility may create different expectations and therapeutic results. These framing choices highlight the need for further research into how therapist beliefs and behaviors contribute to both benefits and risks.
The study emphasizes the importance of psychotherapy process research, which investigates what takes place between therapists and patients during sessions. While integration therapy, the drug-free sessions following psychedelic dosing, helps patients make sense of their experiences, little is known about which therapeutic techniques are most effective. Exploring these techniques could help optimize long-term outcomes and minimize potential risks.
The authors also raise concerns about the limited diversity in PAP research. Most clinical studies have focused on narrow populations, limiting the generalizability of findings. The inclusion of diverse communities and perspectives, both within clinical trials and from practitioners with longstanding experience in non-medical settings, could improve the safety, efficacy, and cultural relevance of PAP.
Another critical area involves listening to patients who have experienced harm during PAP. Understanding their experiences may help refine risk-benefit assessments, improve informed consent practices, and establish stronger ethical guidelines for therapists.
The authors advocate for a more comprehensive approach to PAP research that integrates diverse voices, examines therapist-specific influences, and focuses on the therapeutic process itself. By adopting a stance of epistemic humility and acknowledging the limitations of current knowledge, future research can help build a safer and more effective framework for psychedelic-assisted psychotherapy.
Reference: O’Donnell Kc et al. Healing, Harms, and Humility: Expanding the Scope of Psychedelic-Assisted Psychotherapy Research. Am J Psychiatry. 2025;182(1).
Anaya Malik | AMJ
