Advocacy & Safe Practices in Psychedelic Therapy

In the last five years, psychedelic therapy has once again boomed after a long hiatus since psychedelics were criminalized starting in the late ‘60s. Clinical trials were put on pause, and unfortunately, we lost years of research potential.

Clinicians, researchers, and psychonauts are now back in drive as psychedelics are once again being studied for their powers to enhance new therapeutic practices. With that, psychedelics may soon find their place within the mainstream health-care system.

Just recently, the California Senate approved a bill legalizing the possession of psychedelics like psilocybin mushrooms, DMT, ibogaine, LSD, and MDMA — for adults 21 and older.

Moreover, the Multidisciplinary Association for Psychedelic studies (MAPS), expected its treatment using MDMA to be approved by 2022.

Current research demonstrates that psychedelic-assisted therapy has shown to improve mental wellness in patients dealing with trauma, PTSD, addiction, migraines, and treatment-resistant mood disorders — and the research is far from concluded.

But, with all the healing that psychedelic-assisted treatments can offer come risks of serious harm without essential safeguards in place. It is our hope at MINDCURE to inform and foster these safe spaces within the branch of psychedelic-assisted therapy to ensure that while we wait for legalization, the steps forward are not sullied by malpractice and/or abuse.

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Why We Need to Talk About Safety

Since its inception as an underground practice, psychedelic-assisted therapy has involved quite a few factors that allowed for sexual misconduct. Its criminal nature contributed to the risk of abuse, preventing people from developing systems for accountability and recourse that are normally available in other communities.

Practitioners have often informally taken on the role of therapist or guide for colleagues or friends. With this, roles aren’t always clearly defined, complicating issues of power and influence. 

In 2020, Quartz detailed claims of sexual abuse within the psychedelic therapy community and brought forward against clinicians involved in a MAPS clinical trial. What’s worse, the article went on to mention the efforts that were put in place by leaders of the psychedelic community to silence these claims for the fear that these stories of sexual abuse would undo all the progress thus far.

In the ever-continuing wake of the METOO movement, these claims are disturbing to find in a community built on understanding and healing. Patients were suffering from sexual abuse and subsequently silenced. 

This is but one example highlighting the issues that can arise in treatments with highly vulnerable patients, due in part by the power imbalance with therapists and the obvious triggers of mental health.

In particular, MDMA (the substance used in the MAPS trial) has been studied and noted (since the ‘80s) to “create feelings of sexual arousal and emotional intimacy that can make patients more vulnerable to sexual pressure,” as noted in the head of MAPS, Rick Doblin’s Harvard University doctoral thesis. 

The bottom line is that “clinicians are in a position of authority over clients,” said Carole Sinclair, chair of the Canadian Psychological Association’s ethics committee. The potential for abuse is potent by taking advantage of that authority.

As it stands now in the US and Canada, psychologists are prohibited from having sexual relationships with therapy clients for two years after completing treatment. Sinclair, went on to point out that a sexual relationship is considered abusive because it takes advantage of the trust and dependence of the therapeutic relationship.

And as psychedelic therapy swiftly marches towards full legalization, these claims demonstrate that there aren’t sufficient protocols to protect patients from sexual abuse.

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How Can Safety & Advocacy Be Integrated into Practice?

Sexual abuse is prevalent throughout society, occurring in both standard and psychedelic-assisted therapy. While psychedelic therapy has the added risk of putting patients under the influence, it requires exceptional patient protections apart from those of traditional psychiatry.

As scientific research pushes psychedelic therapy towards legality, there are growing demands for protocols to protect against and discipline sexual misconduct.

Such protocols for treatment, trials, and studies would ensure:

• Stronger oversight in clinical trials
• Tighter sanctions to prevent abuse
• Strict regulations that govern who can provide psychedelic-assisted therapy

The good news is that psychedelic-assisted therapy and its practitioners are responding swiftly to implement and ensure these protocols are being followed.

In the ‘80s, after well-known practitioners were found to be engaging in abusive sexual behavior, clinical trials implemented a rule that ensured two therapists per patient, providing both practical and therapeutic benefits.  

After the allegations in 2018 the MAPS clinician, stronger safeguards were established to “eliminate future ethical violations by these and any other prior, current, or future therapists working for MAPS,” according to a statement released in 2019. MAPS also began to warn subsequent patients about the potential for sexual abuse, listing “emotional openness” as a risk.

MAPS is currently “continuing to develop appropriate channels for receiving and addressing grievances,” Doblin said in an email to Quartz.

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The Future of Psychedelic Therapy 

For psychedelic-assisted therapy to be safe, a board of ethics is needed to help monitor and sanction its clinicians. A successful board is one that is collectively appointed by the community and not chosen by the organization.

And when therapists are regulated, equipped with ongoing training and supervision, patients will have some kind of recourse and trust in their health providers.

For example, iSTRYM connects clients with reputable sources of information and vetted clinics offering psychedelic-assisted therapy and trials.

At MINDCURE, safety is at the forefront of everything we do. To read more on our research, our commitment to safe psychedelic-assisted therapy treatments and our hope for the future check out our blog.