Toward Consensus in Psychedelic-Assisted Therapy: The Critical Role of Psychotherapeutic Support

See reply by Bender et al and article by Bender et al

To the Editor: Psychedelic-assisted therapy (PAT) combines psychedelics, such as psilocybin, with guided psychotherapeutic support.¹ These substances interact with patient’s mindset (“set”) and the surrounding environment (“setting”),² making the context of the experience a critical factor in therapeutic outcomes. As these substances gain recognition for their therapeutic potential, it is essential to investigate how psychotherapy interacts with and shapes the efficacy of these substances.³ The role of PAT is to enhance safety and effectiveness while minimizing the risk of an aversive effect, such as anxiety or psychosis.¹

A recent JCP article by Bender and colleagues¹ examined psychedelic practitioners’ views on psychological support in PAT, categorizing responses into emotive (focusing on human and spiritual) and neuromodulatory (focusing on pharmacological effects) approaches. Forty PAT practitioners from 4 countries participated, overseeing a total of 1,656 sessions. Key themes included creating an emotional setting, the role of spirituality, and understanding negative experiences. While respondents slightly favored an emotive approach, there was no consensus on psychological support strategies.¹ The authors have identified an important knowledge gap; as psychedelics gain therapeutic support in several countries, establishing best practice guidelines is crucial. However, even among experienced experts, there is currently no consensus on best practices.^1,3

This lack of consensus underscores the challenges in developing clear clinical guidelines. Notably, in 2023, Australia developed strict protocols outlining the use of psilocybin and MDMA for the management of treatment-resistant depression and posttraumatic stress disorder (PTSD). As part of these comprehensive guidelines, psychiatrists must obtain Authorized Prescriber (AP) status, which requires regulatory approval prior to implementation. Although Australian guidance emphasizes evidence-based approaches, they still lack clearly defined standards for psychotherapeutic support.³

While consensus on best practice guidelines for psychedelic therapy remains elusive, insight may be gained by examining the naturalistic roots of psychedelic use. In indigenous cultures, psychedelics are often used communally. Preliminary evidence suggests that group therapy using psilocybin can safely reduce depressive symptoms in patients with cancer and major depressive disorder.² A systematic review supports these findings, indicating that the combining psychedelics with group therapy shows promise for treating psychiatric disorders like depression, anxiety, and PTSD. Among the 12 studies included in the review, lysergic acid diethylamide (LSD) was the most commonly used substance, with psilocybin used in 2 studies. Four studies focused on inpatient alcohol treatment programs, with mixed results regarding efficacy. Safety could not be reliably determined due to inconsistent adverse event reporting, but no serious adverse events were noted. The review concludes that psychedelic therapy is generally safe and well tolerated in controlled environments. These data not only bolster the case that therapeutic administration of psychedelics can be done safely but also lend support to the therapeutic role of the emotive approach. Existing psychedelic protocols, whether individual or group, emphasize physiological and psychological safety, including through screening, preparation, psychotherapeutic support, and integration. As guidelines are established, it may be of benefit to incorporate lessons learned from indigenous experiences as well as the scientific evidence emerging from group therapy with psychedelics.^4,5

In conclusion, psychotherapy is essential for the safety and efficacy of psychedelic-assisted therapy. Despite their potential, a lack of consensus on best practices for psychological support highlights the need for standardized guidelines as psychedelics gain global recognition. Insight from naturalistic settings emphasizes the importance of group dynamics and context. Rigorous research is crucial to clarifying mechanisms, long-term effects, and optimal protocols for integrating psychedelics into mainstream treatment.

Article Information

Published Online: September 1, 2025. https://doi.org/10.4088/JCP.25lr15978
© 2025 Physicians Postgraduate Press, Inc.
J Clin Psychiatry 2025;86(4):25lr15978
To Cite: Modesto-Lowe V, Sgambato D, Chaplin M. Toward consensus in psychedelic-assisted therapy: the critical role of psychotherapeutic support. J Clin Psychiatry 2025;86(4):25lr15978.
Author Affiliations: School of Health Sciences, Quinnipiac University, Hamden, Connecticut (Modesto- Lowe, Sgambato); Farrell Treatment Center, New Britain, Connecticut (Chaplin).
Corresponding Author: Deanna Sgambato, DMS, MHS, PA-C, School of Health Sciences, Quinnipiac University, 275 Mount Carmel Ave, Hamden, CT 06518 ([email protected]).
Relevant Financial Relationships: None.
Funding/Support: None.
ORCID: Deanna Sgambato: https://orcid.org/0000-0002-8441-3712