Addressing the Gaps in Participant Care in Psychedelic Therapy and Retreats
Things don’t always go smoothly in psychedelic-assisted therapy or during a psychedelic retreat. In an ideal world, a psychedelic experience would unfold as one hopes. Perhaps there are difficult moments, but they are easily worked through. More generally, people hope the experience will result in catharsis, resolution, and transformation. However, the reality is that psychedelic experiences can often be overwhelming, confusing, and messy. They can result in spiritual emergencies, anxiety, transference, and even conflict with facilitators.
Despite this, psychedelic therapy and retreat websites largely focus on the benefits (which makes sense, given they want to attract new clients), with risks and adverse effects hidden in the small print. Jules Evans and I raised this issue in an article for Ecstatic Integration; we found that many psychedelic therapy training schools didn’t mention even adverse experiences, extended difficulties, or harm reduction on their websites and course descriptions.
Most psychedelic retreats also appear to lack a mediation or complaints procedure, with participants (and their loved ones) often left to pick up the pieces and figure it out on their own. And in the context of psychedelic therapy, there is also no standardised way to deal with adverse effects.
While this gap in ethical oversight and participant support is common in the psychedelic industry, the use of psychedelics for therapeutic purposes is still being legalised in certain countries and US states. It would’ve been prudent to have a greater focus on participant support before making psychedelic medicine legally available, which should include adequate funding for this aspect of treatment. But it’s still possible to course correct. Psychedelic clinics and retreats can ensure that ethical oversight and ongoing participant support become a priority rather than an afterthought.
Psychedelic Healing Often Lacks Safeguards
It’s often assumed that all or most of the dangers associated with using psychedelics therapeutically come down to using them in an unregulated, unprofessional context. This could mean using them on one’s own, with strangers, with untrustworthy or inexperienced people, or in underground psychedelic therapy or retreats. Nevertheless, risks remain when taking psychedelics at legal and regulated psychedelic clinics and retreats. The fact that clinics and retreats have to meet certain regulatory requirements doesn’t mean that adverse effects can’t occur. Even at the most renowned, professional, and expensive clinic or retreat, it’s still possible for someone to come away from the experience feeling destabilised and without support.
There are many ways in which the psychedelic industry lacks safeguards for participants. Some of them we have touched on already. Let’s delve a bit deeper into them.
Insufficient Integration Sessions
Many participants describe how there was a lack of adequate integration support after their experiences. Paul Sinclair reflects on this in the context of his own retreat experience:Though beautifully orchestrated, the ceremonies felt more like a conveyor belt operation than a personalised healing experience. The facilitators, though well-meaning, were spread thin, managing a large group without being able to provide the individual attention and support that such a profound experience demands. The physical environment was serene but did little to compensate for the lack of genuine, personalised care.What followed was an overwhelming onslaught of emotions and memories and a 6-hour somatic release of extensive childhood and military trauma that I wasn’t prepared to face. Issues I had buried deep within myself surfaced with a force that left me reeling. The ceremonies opened doors to the deepest parts of my mind, body, and spirit, but these insights became so heavy that I could not carry them on my own, and they broke me.
After the retreat with two ceremonies, I was largely left to my own devices. The integration support was minimal and generic—one short call with one of the facilitators was all. Then, I was thrown into a WhatsApp group with other vulnerable people trying desperately to make sense of their psychedelic experiences. I found myself grappling with intense emotions and unresolved issues without the necessary guidance to process them. The lack of structured follow-up sessions, emotional and spiritual support, and practical coaching left me stranded and unable to cope.
My wife, who tried her best to support me, was unprepared and overwhelmed by the intensity of what I was experiencing. The strain on our relationship was immense, and without a solid support system, I relapsed into old, destructive patterns, worse off than before.
No Guidance on Where to Turn for Support
If participants are struggling after a psychedelic treatment or retreat, they may not be able to find any information from the clinic or retreat on where to find ongoing support. They might be given some general recommendations about trying psychotherapy or finding an integration group, but receive no specific information on how to find these forms of support. Essentially, for some participants, once the treatment or retreat is over, they find themselves in the situation Paul Sinclair was in: they were part of a conveyor belt operation, and once the program comes to a close, they are left to figure things out on their own.A Lack of a Proper Complaints Procedure
Often, if a participant isn’t happy with how a psychedelic treatment or retreat experience turned out, their only option is to leave a negative review. Ideally, a clinic or retreat will have a mediation of complaints procedure in place, so that participants who feel distressed or mistreated have the ability to get the issue resolved. At worst, a clinic or retreat doesn’t take participants’ complaints seriously at all and instead shifts the blame onto them. This is particularly concerning when a participant suffers abuse at the hands of a psychedelic therapist, facilitator, or shaman. In his 2022 book The Psychedelic Handbook, Rick Strassman addresses this issue in a section on “unscrupulous practitioners”:Whether in group or individual settings, some who administer psychedelic drugs do not have the best interest of their charges in mind. They may manipulate, abuse, or otherwise take advantage of someone in a psychedelically induced, vulnerable and suggestible state […] One factor making it so hard to sound the alarm is the charisma of the perpetrators, their standing in the psychedelic community—spiritual, academic, or therapeutic—and the gaslighting and blame projecting that they often invoke as their first line of defence. ’It’s nothing, you’re overreacting.’ ’You’re imagining it.’ ’It must be some problem you have.’ ‘They seduced me.’ ‘I was only doing it for their benefit.’ And so on. We are now witnessing a welcome frankness of discussions of this phenomenon.
How to Improve Ethical Oversight
A lack of ethical oversight is not a problem in every psychedelic clinic and retreat, of course; while this is an industry-wide problem, it is not a universal one. Many psychedelic therapists and retreat leaders place a high priority on participant safety and care, specifically in the context of mediation, complaint procedures, and facilitating support after the treatment program is over. For example, Numinous Ways, which organises psychedelic retreats, has a support mechanism in place: if issues arise, participants can access external mediation and additional integration services. Psychedelic journeys can be intense and complicated, so it’s vital that ongoing support is available to meet the diverse needs that participants have.
Evans has written about some ways forward in building a psychedelic safety network:
Psychedelic harms occur and will continue to occur, but does the field learn from harms and improve its practices? If it doesn’t, there is no learning, people merely suffer in silence or go to the press.One suggestion is the evolution of a psychedelic harm network, formal or informal, to connect researchers, clinics, retreats, churches, training schools, underground guides, dispensaries and consumers - to learn from harms through surveys, case studies and consumer complaints, share that information and try to learn from it….
This sort of network already exists in an informal sense but it could be more joined up. What would that look like in practice? It could be as informal as a mailing list to share articles and case studies, or the creation of some working groups, or more ambitiously it could be the establishment of some sort of jointly-run online registry of harms.
The potential issues for this greater connectedness and joined-up learning are: 1) how to react if someone reports harm from a particular person or organisation, and what if that person or organisation is part of the network? Could some sort of mediation process be developed? 2) competition for funding and prominence could get in the way of collaboration. And finally 3) politics could get in the way - people might have directly competing visions of how the field should look (decriminalized vs medical, profit-driven vs social-driven). Or they might just have beefs with others in the network - this is a small field with a long history of in-fighting!
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