What Does Good Psychedelic Therapy Look Like? – The New York Times

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As MDMA and psilocybin treatments become more mainstream, the therapy component has come under scrutiny. Here’s what’s common in many sessions — and what’s not.

Psychedelic therapy is on its way to becoming a mainstream medical treatment in mental health care. In 2020 and 2022, residents of Oregon and Colorado voted to legalize the use of psilocybin, the psychoactive ingredient in hallucinogenic mushrooms, and the Food and Drug Administration is expected to approve it and MDMA, or Ecstasy, to treat depression and post-traumatic stress disorder by 2024.
While there is mounting evidence that psychedelics could offer much-needed new treatments for intractable mental illness, stories of abuse or trauma have also emerged — which have more to do with the therapists than the drugs.
Some cases involve clear instances of sexual assault. With others, the therapist may have had good intentions but still caused more harm than healing. In one recent clinical trial, which found that psilocybin could offer relief for treatment-resistant depression, three participants reported having suicidal thoughts and harming themselves in the weeks following the therapy.
Twenty years of research has standardized the dosage of the drugs used in clinical trials, but the therapy part has not received similar scrutiny. Instead, therapists’ work is often based on tradition rather than empirical evidence, said Dr. Charles Raison, the director of clinical and translational research at the Usona Institute in Wisconsin and a professor of psychiatry at the University of Wisconsin.
The lack of scientifically backed best practices has prompted researchers, clinicians and former patients to call for a more critical look at the therapeutic component of psychedelic therapy.
“I’m really concerned about the ways in which well-meaning therapists can do harm,” said Sarah McNamee, a licensed psychotherapist and research coordinator at the School of Social Work at McGill University.
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