Agency, informed consent and transformative experiences: A proposed conceptual analysis of the ethical challenges of psychedelic-assisted psychotherapy
Szabina Péter, János Kristóf Bodnár
Journal of Psychedelic Studies October 30, 2026 DOI: 10.1556/2054.2026.00562 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Conceptual commentary Longitudinal Peer reviewed |
|---|---|
| Topics | Psychedelic-assisted therapy |
| Key points | Argues that psychedelic transformation in PAP is better understood as a phased process—rapid trigger, interpretation/integration, and long-term outcomes—across which patient agency varies. Contends that informed-consent challenges, including persistent and regretted personal change, do not by themselves justify psychedelic ethical exceptionalism, and proposes enhanced disclosure of transformative uncertainty, attention to susceptibility during acute and interpretative phases, and follow-up practices that support patient agency. |
Abstract
Abstract: Recent discussions of psychedelic-assisted psychotherapy (PAP) have raised concerns about its potential to produce unpredictable and persistent personal transformations that patients cannot fully anticipate and may subsequently regret. These concerns pose challenges for informed consent and have contributed to arguments for psychedelic ethical exceptionalism. In this conceptual commentary, we propose a process-based, agency-sensitive account of personal transformation. Rather than treating psychedelic transformation as a ‘single’ event imposed upon a ‘passive’ subject, we distinguish between a potentially rapid transformative trigger, the subsequent process throughout which psychedelic experiences are interpreted and integrated, and its longitudinal outcomes. Patients' agency may vary across these phases, being particularly compromised during acute psychedelic experiences while playing a greater role during preparation, integration, and longer-term reflection. This account does not eliminate the informed-consent challenges associated with PAP, including the possibility of persistent and regretted personal change, but suggests that they do not by themselves require a fundamentally exceptional framework for informed consent. We argue instead for enhanced disclosure of transformative uncertainty, attention to patients' susceptibility during acute and interpretative phases, and follow-up practices that support patients' agency in responding to persistent personal changes.
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 |
Citations in the library
Cites 10
- Ethics and ego dissolution: the case of psilocybin Journal of Medical Ethics May 27, 2020
- Transformative experience and informed consent to psychedelic-assisted psychotherapy Frontiers in Psychology May 26, 2023
- Giving consent to the ineffable Neuroethics February 15, 2024
- Psychedelic Medicine Exceptionalism. The American Journal of Bioethics 2025
- Are Psychedelic Experiences Transformative? Can We Consent to Them? Perspectives in biology and medicine 2024
and 5 more in the library