A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing
Margo A. Jackson, Joseph G. Ponterotto, Bill Brennan, Katherine A Maclean
Journal of Humanistic Psychology September 16, 2021 DOI: 10.1177/00221678211045265 (opens in new tab)
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Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study Peer reviewed |
|---|---|
| Sample size | 23 |
| Population | Practitioners who have administered MDMA and psilocybin to clients in underground healing contexts |
| Topics | MDMA Psilocybin |
| Keywords | Competence human resources Psychotherapist Watson Qualitative research |
| Citations | 53 |
| Key findings | Practitioners face unique relational ethical challenges in underground psychedelic work, including client nudity and the use of touch, and have developed prescriptive practices to address these challenges. |
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.
Comparable studies
Other qualitative studies on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Phenomenology and Sequelae of 3,4-Methylenedioxymethamphetamine Use Psychiatrists who had taken MDMA | 1992 | Qualitative study | n = 20 |
| MDMA and Sexual Behavior: Ecstasy Users' Perceptions About Sexuality and Sexual Risk Current and former users of MDMA | 2005 | Qualitative study | n = 98 |
| Perceived Benefits of MDMA-Assisted Psychotherapy beyond Symptom Reduction: Qualitative Follow-Up Study of a Clinical Trial for Individuals with Treatment-Resistant PTSD Veterans, firefighters, and police officers with chronic, treatment-resistant PTSD | 2019 | Qualitative study using interpretative phenomenological analysis | n = 19 |
| Negative Experiences on Ecstasy: The Role of Drug, Set, and Setting Current or former users of Ecstasy | 2002 | Qualitative study | n = 98 |
| Patterns, Trends, and Meanings of Drug Use by Dance-drug Users in Edinburgh, Scotland Clubbers in clubs and pre-club bars | 2004 | Cross-sectional survey with focus groups | n = 124 |
Citations in the library
Cited by 44
- Transformative experience and informed consent to psychedelic-assisted psychotherapy Frontiers in Psychology May 26, 2023
- With great power comes great vulnerability: an ethical analysis of psychedelics’ therapeutic mechanisms proposed by the REBUS hypothesis Journal of Medical Ethics April 12, 2023
- Perceptions and attitudes towards psychedelic-assisted psychotherapy among health professionals, patients, and the public: A systematic review Journal of Psychedelic Studies February 5, 2024
- Spiritual health practitioners’ contributions to psychedelic assisted therapy: A qualitative analysis PLoS One January 2, 2024
- Altered stakes: Identifying gaps in the informed consent process for psychedelic-assisted therapy trials Journal of Psychedelic Studies November 20, 2023
and 39 more in the library
Cites 22
- Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial Journal of Psychopharmacology November 30, 2016
- Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial Journal of Psychopharmacology November 30, 2016
- Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. The Lancet Psychiatry May 17, 2016
- Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder JAMA Psychiatry November 4, 2020
- Pilot Study of Psilocybin Treatment for Anxiety in Patients With Advanced-Stage Cancer Archives of General Psychiatry September 7, 2010
and 17 more in the library