# The ethical use of therapeutic touch in psychedelic-assisted therapy: a qualitative study of researcher perspectives and experiences

## TL;DR

Researchers explored how to ethically use therapeutic touch in psychedelic therapy by interviewing experts about consent and boundaries.

## Contribution

The study provides new insights into ethical frameworks for therapeutic touch in psychedelic-assisted therapy through qualitative analysis of researcher perspectives.

## Key findings

- Building a strong therapeutic alliance is crucial for managing consent to touch in PAT.
- Consent to therapeutic touch should be ongoing and not a one-time agreement.
- Clear ethical guidelines are needed when participants change their preferences during treatment.

## Abstract

Physical touch is often included as a supportive or therapeutic tool in psychedelic-assisted therapy (PAT), involving instrumental forms of physical contact, supportive touch and somatic techniques. However, participants under the influence of psychedelics have reduced capacity to provide consent, are more suggestible and may experience and interpret therapeutic touch in ways they did not expect prior to taking the drug. Yet little research has been conducted on the considerations and approaches to therapeutic touch in clinical trials of PAT.

This study explored the experiences and perspectives of PAT researchers on the use and consent to therapeutic touch in clinical trials of PAT.

A qualitative study using semi-structured interviews.

Sixteen PAT researchers involved in clinical trials of PAT were interviewed. Reflexive thematic analysis was used to analyse the data. The reporting of this study conforms to the Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ).

Three themes were uncovered through reflexive thematic analysis: (1) flexible frameworks, (2) therapeutic alliance and (3) boundary management. Researchers discussed consent challenges across the broad spectrum of physical contact existing in PAT protocols at the time. Researchers indicated that consent to therapeutic touch should be established prior to the dosing sessions and continually managed throughout the course of treatment. Flexibility in consent protocols enabled researchers to interpret and approach consent through the development of a strong therapeutic alliance; however, flexibility could also lead to challenges in boundary management. Researchers emphasised the need for greater ethical guidance in instances where trial participants change their established preferences during dosing sessions, and limits on expanding consent after drug administration.

Clear guidelines for obtaining consent, managing changing preferences and training on the management of boundary transgressions were viewed as essential for ethical research and practice of PAT.

The ethical use of therapeutic touch in psychedelic-assisted therapy

There is a growing body of research studying how mind-altering drugs, when used with therapy, may help treat mental health conditions. This type of therapy is called psychedelic-assisted therapy (PAT). During “dosing” sessions, participants take a carefully controlled psychedelic drug while receiving support from therapists. Therapists sometimes use touch, such as holding hands or reassuring support, to provide therapeutic care. Participants must consent to specific forms of touch prior to treatment.

Why This Research Matters

Getting consent for touch in PAT requires special attention because:

- Psychedelic drugs change how people think and understand information

- People might experience touch differently than expected while under drug effects

- Participants are more vulnerable and easily influenced

There are no clear guidelines for consenting participants to touch during these studies. We interviewed 16 researchers involved with PAT trials to learn about their views on obtaining and managing consent for therapeutic touch throughout treatment.

Key Findings

- Building trust between therapists and participants is very important for consent

- Agreeing to touch is not a one-time event. It requires ongoing discussion

- Therapists need better guidance about what to do when drug-affected participants change their minds about touch

Our research shows that clear guidelines are essential.

Research teams could benefit from incorporating our recommendations for:

- Managing situations when participants change their minds about touch

- Safe, ongoing communication about touch throughout treatment

- Managing clear boundaries between therapists and participants

Implications

As clinical trials of PAT expand, our findings provide a framework to inform the development of guidelines to ensure the highest level of participant safety, ethical care, and clear professional standards.