A Qualitative Inquiry into Ethical Relationship and Boundary-Setting in Underground Psychedelic Healing

William Thomas Brennan, Fordham University


As both MDMA- and psilocybin-assisted psychedelic psychotherapy near FDA approval and gain acceptance as efficacious clinical approaches, concerns have been raised about their alleged proneness to therapist sexual abuse and other relational boundary transgressions. In the current study, 23 practitioners who have administered MDMA and psilocybin to clients in underground healing contexts were interviewed about their experiences navigating multiple relationships, non-sexual touch, and maintaining sexual boundary-setting in their work. Twelve of these practitioners have undergone formal, graduate-level training in psychotherapy. 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 “best 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.

Subject Area

Counseling Psychology|Therapy

Recommended Citation

Brennan, William Thomas, "A Qualitative Inquiry into Ethical Relationship and Boundary-Setting in Underground Psychedelic Healing" (2022). ETD Collection for Fordham University. AAI28259305.