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Transformative experience and informed consent to psychedelic-assisted psychotherapy

Edward Jacobs

Frontiers in Psychology May 26, 2023 DOI: 10.3389/fpsyg.2023.1108333 (opens in new tab)

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AI-extracted from the abstract
Characteristics Theoretical or philosophical paper Peer reviewed
Intervention Psychedelic-assisted psychotherapy
Topics Psychedelic-assisted therapy
Keywords Transformative learning Psychotherapist Informed consent Integrative psychotherapy Psychoanalysis
Citations 61
Key points Argues that prospective patients in psychedelic-assisted psychotherapy cannot meet the understanding requirement of informed consent due to the epistemically inaccessible nature of the transformative experiences involved.

Abstract

Just as psychedelic-assisted psychotherapy (PAP) represents a clinical innovation that may need to be accommodated with corresponding theoretical and methodological innovations, there is growing awareness that the tools, normative frameworks, and standard practices of our clinical ethics may also need to be adapted, renewed, or replaced to accommodate its unusual features. Drawing on L. A. Paul's work on “Transformative Experience,” I argue that the acute and long-term effects that are repeatedly reported following the administration of psychedelic drugs, including in clinical contexts, are epistemically inaccessible at the point of deciding to take them. By virtue of both the so-called “mystical” experiences that frequently arise during PAP, and the long-term shifts to outlooks, values, and priorities that can follow treatment, the processes of decision-making that are normatively expected of patients run aground. If this framing is correct, then prospective patients cannot meet the requirement of understanding that is one of the principal analytic components of informed consent. The role of understanding in supporting two functions of informed consent—avoiding unauthorized trespass against patients and supporting values-aligned decision-making—is explored, and I argue that, while the normative standard for the first function may be met by extant suggestions for enhancing the consenting process for PAP, the latter function remains unattainable. In light of this, the consequences for the ethical preparation of prospective patients are considered.

Comparable studies

Other theoretical and historical papers on psychedelic-assisted therapy, most cited first.

Study Year Design Participants
Theorizing that Psychedelic Assisted Therapy May Play a Role in the Treatment of Trauma-Induced Personality Disorders. 2024 Theoretical or philosophical paper
Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance 2020 Theoretical or philosophical paper
Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy 2018 Theoretical or philosophical paper
Ethical and legal issues in psychedelic harm reduction and integration therapy 2021 Theoretical or philosophical paper
Towards psychedelic apprenticeship: Developing a gentle touch for the mediation and validation of psychedelic-induced insights and revelations. 2022 Theoretical or philosophical paper

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Psychedelic-assisted therapy Mystical experience Mysticism