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A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing

As both 3,4-methylenedioxymethamphetamine (MDMA)- and psilocybin-assisted psychedelic psychotherapy near U.S. Food and Drug Administration (FDA) approval and gain acceptance as efficacious clinical approaches, concerns have been raised about the likelihood of sexual violation of a client and other relational boundary transgressions. In the current study, 23 practitioners who have administered MDMA and psilocybin to clients in underground (i.e., extralegal) healing contexts were interviewed about their experiences navigating multiple relationships, nonsexual touch, and sexual boundary-setting in their work. Of these practitioners, 12 had undergone formal, graduate-level training in psychotherapy, 10 identified as female, and 13 identified as male. A phenomenological research design was used to assess what unique relational challenges they have faced in this work and what practices they have found helpful in doing so. Two sets of themes addressing these two questions were developed from the data. Descriptive themes represent the unique challenges that psychedelic practitioners have encountered in their work, and prescriptive themes are made up of the practices they have found most useful in confronting these challenges. Some themes are unique to psychedelic work (e.g., client nudity, the use of touch, the belief that therapists must continue to have their own psychedelic experiences), while others represent a psychedelic-specific take on standard ethical considerations (e.g., transference, supervision, staying within one’s scope of competence). Discussion of these results includes implications for the training of psychedelic psychotherapists and other regulatory decisions facing the field.