Navigating Ethical Challenges in Psychedelic Therapy
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Chapter 1: Understanding the Risks
Recent discussions have brought to light the pressing need to address ethical challenges in the realm of psychedelic therapy, particularly in light of past incidents of sexual misconduct.
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Clinical trials involving psychedelic therapies have shown remarkable potential in addressing mental health disorders. However, new studies indicate that ethical dilemmas related to these therapies are abundant. A key concern highlighted in a recent article published in the Journal of Humanistic Psychology is the occurrence of sexual abuse between therapists and their clients during psychedelic sessions. The aim of the researchers is to propose strategies to prevent such incidents as psychedelic therapy gains broader acceptance.
Section 1.1: The Vulnerability Factor
The nature of psychedelic therapy, whether through MDMA or psilocybin, raises significant ethical questions. During these sessions, the power imbalance between therapist and client becomes pronounced; individuals often arrive with pre-existing mental health challenges, compounded by the effects of potent psychedelics.
Unfortunately, this dynamic can lead to situations where some therapists take advantage of their clients' vulnerabilities. Reports of sexual abuse within psychedelic therapy surfaced as recently as 2018, during an FDA phase III trial for MDMA aimed at treating PTSD. While these issues are alarming, they are not exclusive to psychedelic therapy. Traditional talk therapies report similar rates of abuse, estimated at 7–12%. This raises a crucial question: If sexual abuse is prevalent in conventional therapies, what might the rates look like as psychedelic therapies become mainstream? How can we mitigate these risks?
Subsection 1.1.1: Insights from Underground Therapists
To tackle these pressing questions, the authors of the recent study conducted interviews with 23 underground psychedelic therapists. They discussed the ethical dilemmas that may arise during therapy and proposed potential preventative measures.
Some therapists noted that lengthy sessions and the therapeutic use of touch can foster an intimacy not typically found in standard talk therapies. The authors explain, “Many [therapists] felt that this intimacy is part of what is therapeutic about psychedelic work. However, they noted that it has also led to ethical boundary challenges, often by inadvertently encouraging romantic feelings in the client.”
The effects of MDMA, which can include increased empathy and sexual arousal, may further complicate these boundaries during therapy sessions. This highlights the critical importance of being aware of the patient’s vulnerability throughout the process.
One significant aspect of prevention discussed was the matter of consent. A therapist shared their two-stage consent procedure regarding touch: “Before we even begin the experiential session, I ask, ‘Is it OK if I work with your body or touch you?’ If they decline, I will respect that. Even if they agree, I will check in during the session, asking, ‘Can I place my hand on your shoulder, your chest, your belly?’”
Other therapists stressed the importance of having supervision during sessions. Implementing a standard practice of having two therapists present—one male and one female—could serve as a valuable safeguard against potential transgressions.
Chapter 2: Moving Forward with Caution
The emerging field of psychedelic therapy presents unique ethical challenges.
The existing power imbalance between therapist and client is magnified when psychedelic substances are introduced. The authors of the study assert that psychedelic therapy is “fraught with unique ethical challenges that necessitate self-awareness and practical solutions that extend beyond conventional psychological training.”
Nevertheless, this research marks a positive development. It is hoped that organizations will take this information seriously and establish stricter guidelines for practitioners in the field.
The first video titled "Psychedelic Sexual Abuse: Why Does it Happen--and How to Stop It" delves into the alarming issue of sexual abuse in psychedelic therapy settings, aiming to identify root causes and propose actionable solutions.
The second video "Clinical Psychedelic Therapy for Sexual Trauma and Pelvic Pain" explores the therapeutic potential of psychedelics for individuals dealing with sexual trauma and related physical pain, emphasizing the importance of ethical practices in therapy.