“So many relationships in the room”: Participant perspectives on the affordances and challenges of co-therapy in psychedelic assisted therapy
Rachel Ham, John Gardner, Adrian Carter, Paul Liknaitzky
September 26, 2025 preprint DOI: 10.31234/osf.io/4cn5r_v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study |
|---|---|
| Sample size | 18 |
| Population | Participants in a trial of psilocybin-assisted therapy for generalized anxiety disorder |
| Intervention | Psilocybin-assisted therapy |
| Topics | Anxiety Psychedelic-assisted therapy |
| Keywords | Context archaeology Therapeutic relationship Affordance Perspective graphical Qualitative research Credibility Participant observation Psychotherapist Exposure therapy Single-subject design Clinical trial |
| Key findings | Participants generally valued cotherapy, which served as both a safety and supportive measure and a potentiator of therapeutic processes. |
Abstract
Psychedelic-assisted therapy (PAT) frequently utilises a “cotherapy” model, in which two therapists jointly support participants or patients through preparation, dosing, and integration sessions. While common in clinical trials, the experience of cotherapy from the participant perspective remains underexplored. This qualitative study examined experiences of cotherapy within a trial of psilocybin-assisted therapy for generalised anxiety disorder. Semi-structured interviews with 18 participants (29 interviews in total) were analysed thematically, guided by Affordance Theory to consider how cotherapy dynamics shaped therapeutic possibilities. Three major themes were developed: (1) Dose day cotherapy: safety, trust and the realities of access; (2) Cotherapy influences therapeutic processes; (3) Cotherapy shapes the impact and credibility of therapeutic insights.Together, these findings position cotherapy in PAT as both a safety and supportive measure, and a potentiator of therapeutic processes. In the context of a single site with high levels of clinician qualification and training, participants generally valued cotherapy. Insights from this study can guide clinical practice and future research, so that feasibility and accessibility are enhanced while preserving the safety and therapeutic benefits afforded by cotherapy.