The Therapeutic Alliance in Psychedelic-Assisted Psychotherapy: A Novel Target for Research and Interventions
Philip Kamilar-Britt, Elana B. Gordis, Mitch Earleywine
Psychedelic Medicine August 18, 2023 DOI: 10.1089/psymed.2023.0020 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Psychedelic-assisted therapy |
| Citations | 15 |
| Key findings | The therapeutic alliance is a promising but understudied mechanism in psychedelic-assisted therapy, and increasing attention to it could improve treatment outcomes. |
Abstract
Clinical trials support the promise of psychedelic-assisted therapy (PAT) and reveal potential mechanisms underlying efficacy. Out of necessity, initial studies of PAT have focused on feasibility and impact with special attention to acute responses to the molecules, but investigations of the psychotherapy components of PAT have lagged other work. Years of research on other forms of psychotherapy reveal that one of the most important contributors to outcome is the therapeutic alliance, a cooperative connection between clients and providers. The alliance has accounted for meaningful variance in psychotherapies independent of their theoretical orientation, number of sessions, and rates of change in improvement. Nevertheless, recent critiques suggest that previous estimates of the alliance's impact were exaggerated because of statistical problems. This controversy only underscores the idea that the alliance could prove a valuable target for understanding mechanisms and enhancing PAT's impact. Initial work shows promise, but only two publications address the issue directly despite decades of emphasis on the alliance in published recommendations for conducting PAT. Adding alliance measures to clinical trials would not require extensive effort or resources. Each practitioner could improve alliance relatively easily, regardless of theoretical orientation, through increases in uncontroversial clinician behaviors that focus on respect for client autonomy, listening skills, and current practical concerns. This article details support for the alliance construct, reviews relevant measurement strategies, and underscores implications for researchers and clinicians. Increased attention to the therapeutic alliance could enhance our understanding of mechanisms underlying PAT and improve outcomes, potentially decreasing human suffering more efficiently.
Comparable studies
Other narrative reviews on psychedelic-assisted therapy, most cited first.
Citations in the library
Cited by 14
- The therapeutic alliance between study participants and intervention facilitators is associated with acute effects and clinical outcomes in a psilocybin-assisted therapy trial for major depressive disorder PLoS One March 14, 2024
- Multidimensional Personality Changes Following Psilocybin-Assisted Therapy in Patients With Alcohol Use Disorder: Results From a Double-Blind, Placebo-Controlled Clinical Trial American Journal of Psychiatry 2025
- Psychedelics and the treatment of eating disorders: considerations for future research and practice. Journal of Eating Disorders October 22, 2024
- An examination of internal family systems interventions for trauma with implications for ethical psychedelic-assisted treatment Journal of Psychedelic Studies March 5, 2024
- "This is you teaching you:" Exploring providers' perspectives on experiential learning and enhancing patient safety and outcomes in ketamine-assisted therapy. PLoS One 2024
and 9 more in the library
Cites 20
- Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology November 8, 2017
- MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine June 1, 2021
- Long-term follow-up of psilocybin-facilitated smoking cessation The American Journal of Drug and Alcohol Abuse July 21, 2016
- Psychedelics and the essential importance of context. Journal of Psychopharmacology February 15, 2018
- Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors Journal of Psychopharmacology October 11, 2017
and 15 more in the library