Understanding Psychedelic-Assisted Psychotherapy Providers' Perspective and Insights: A Qualitative Analysis.
Crystal Lederhos Smith, Nathan Sackett, Brian Connor Stark, Victoria Dinh, Ellen Wager Romesburg, John Roll
Psychedelic Medicine September 1, 2024 DOI: 10.1089/psymed.2023.0074 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study Peer reviewed |
|---|---|
| Population | Underground psychedelic-assisted psychotherapy providers |
| Intervention | psychedelic-assisted psychotherapy |
| Topics | LSD MDMA Psilocybin Psychedelic-assisted therapy |
| Keywords | Psychedelic healing Empathogen Psychedelic facilitators Psychedelic medicine Trip sitters Underground therapists Treatment methods |
| Citations | 4 |
| Key findings | Underground guides articulated consistent yet flexible processes and believed client benefit came from clients' own intrinsic ability to heal, while expressing dissonance about legalization. |
Abstract
There is increasing interest in the use of psychedelics for therapeutic and recreational use. Research has been hindered by federal prohibition, put in place in 1970. Despite the regulatory difficulty, research has rapidly expanded in the past decade. Multiple states and cities have drafted their own policies regarding the use of psychedelics. Assuming interest in psychedelics continues to expand; every opportunity should be explored to better understand how psychedelics may be helping or harming people. This study examined underground psychedelic-assisted psychotherapy providers' protocols and perspectives, to better inform policy and public health, as psychedelics increasingly are used in the United States. Transcripts of interviews were examined through qualitative content analysis. The following four themes were identified: (1) personal experiences and self-healing motivated sharing and promotion of the positive effects of psychedelics as an expression of altruism, (2) guides articulated consistent, yet flexible processes, (3) guides believed that the client benefit was actualized through their own intrinsic ability to heal themselves, and (4) guides expressed an overwhelming sense of dissonance regarding psychedelic legalization, not only desiring increased access and decreased risk but also expressing concern about potential negative impacts on provider flexibility, and depersonalization that could come with standardizing this field of practice. In order for current research and policy to be best informed, information must be gathered from both clinical trials and observational studies of current practice. This study identified themes within the latter to provide perspectives, practices, and insights of current underground practice, so it can be used to inform research and policy moving forward.
Comparable studies
Other qualitative studies on psychedelic-assisted therapy, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Patients’ Accounts of Increased “Connectedness” and “Acceptance” After Psilocybin for Treatment-Resistant Depression Patients with treatment-resistant depression enrolled in an open-label trial of psilocybin | 2017 | Qualitative study | n = 20 |
| LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: A qualitative study of acute and sustained subjective effects Patients with anxiety associated with life-threatening diseases | 2014 | Prospective follow-up with qualitative content analysis | n = 10 |
| Patient Experiences of Psilocybin-Assisted Psychotherapy: An Interpretative Phenomenological Analysis Adults aged 22 to 69 with clinically elevated anxiety associated with a cancer diagnosis | 2017 | Qualitative study | n = 13 |
| Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts Participants who completed a psilocybin-facilitated smoking cessation pilot study | 2018 | Qualitative follow-up study using semi-structured interviews and thematic analysis | n = 12 |
| The hidden therapist: evidence for a central role of music in psychedelic therapy Patients undergoing psychedelic therapy with psilocybin for treatment-resistant depression | 2018 | Qualitative study | n = 19 |
Citations in the library
Cited by 6
- Building standards of psychedelic care: Qualitative examination of expert perspectives on safety, inclusion, and accountability. International Journal of Drug Policy 2026
- Working with post-psychedelic difficulties: a meta-aggregation of users’ experiences and implications for counselling practice Counselling Psychology Quarterly September 27, 2026
- From fragmentation to communion: Western dis-integration and indigenous ecosophies Journal of Psychedelic Studies July 21, 2026
- Naturally Derived Psilocybin for Therapeutic Use: A Six-Criterion Framework for Evidence, Safety, and Benefit–Risk Considerations in Policy and Clinical Development Biomolecules July 3, 2026
- Synergies in psychedelic-assisted therapy: a qualitative interview study of psychotherapeutic processes Frontiers in Psychiatry April 1, 2026
and 1 more in the library
Cites 20
- Patient Experiences of Psilocybin-Assisted Psychotherapy: An Interpretative Phenomenological Analysis Journal of Humanistic Psychology April 28, 2017
- Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts Journal of Psychopharmacology June 25, 2018
- Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development Frontiers in Pharmacology July 5, 2018
- Psychedelic Drug Legislative Reform and Legalization in the US JAMA Psychiatry December 7, 2022
- Ethics and ego dissolution: the case of psilocybin Journal of Medical Ethics May 27, 2020
and 15 more in the library