Touch in the Context of Psychedelic Therapy 

As mind altering substances, psychedelics significantly increase vulnerability, suggestibility, and needs for the client. Psychedelic treatment may also be “last resort” for some individuals who may be more easily influenced. 

Power dynamics are inherent within the practitioner/client relationship. Ensuring practitioner capacity to practice ethically is of utmost importance, this includes a practitioner’s capacity to acknowledge dynamics of power, oppression and privilege as well as to recognize and manage their own feelings, thoughts, and responses (McLane et al., 2021).

When possible, a team is recommended compared to a solo practitioner for the psychedelic session to hold each other accountable. Ideally psychedelic therapy should not be performed with someone with whom you have a personal relationship.

Though certain ethical guidelines may be clear (i.e., no sexual touching), challenges can arise for both clients and practitioners when previously established preferences shift during the medicine session. 

Both (1) ongoing, client-orientated consent practices and (2) development of one’s capacity as a practitioner are fundamental to skillfully navigate touch in psychedelic therapy. In this way, the therapeutic space is monitored both by the client and practitioner. Prioritized here is an awareness of others rights and a need for self-vigilance and attentiveness to one’s own actions, thereby forefronting the mutuality of therapy and appreciation of the moral space in which practice resides (Austin et al., 2006).

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Why is Touch Therapeutic in Psychedelic Therapy?

• Safety & Grounding: Psychedelic experiences can be intense and disorienting, and touch can provide a sense of safety and grounding for individuals navigating altered states of consciousness. Gentle touch, such as holding hands or a reassuring touch on the shoulder can help individuals feel anchored in and connected to their physical bodies, providing a sense of stability and reassurance during the journey
• Trust and Connection: Touch can foster a deep sense of trust and connection between the participant and the therapist or facilitator. By incorporating touch in a respectful and supportive manner, it helps build rapport and create a therapeutic alliance, fostering open communication and the willingness to explore vulnerable aspects of oneself.
• Emotional Release and Comfort: Psychedelic experiences can bring up intense emotions and memories. In such moments, compassionate touch can provide comfort and emotional support, allowing individuals to feel safe to express and release their emotions. A gentle hand on the back or a comforting embrace can offer solace and validation during moments of emotional processing.
• Body Awareness and Integration: Psychedelic therapy often involves body-focused awareness and somatic exploration. Touch can enhance the individual's connection with their body, helping them tune into physical sensations, release tension, and promote a deeper understanding of the mind-body connection. It can facilitate the integration of insights gained during the psychedelic experience into one's embodied existence.
• Energetic Alignment and Flow: Touch can help encourage the movement of energy within the body and support the free flow of emotions and sensations during psychedelic sessions. Therapists or facilitators may use gentle touch or bodywork techniques to promote energetic alignment, release energetic blockages, and assist in the harmonization of the individual's energy system.
• Transpersonal Connection: Psychedelic experiences can often transcend individual boundaries and foster a sense of connection with something greater than oneself. Touch can deepen this transpersonal connection, serving as a tangible reminder of the interconnection between individuals, the therapeutic space, and the broader fabric of existence.

Suggestions for Clients

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Consider what type of touch you feel comfortable with when anticipating a psychedelic session, such as holding hands, shoulders, outer arms, head, feet.

Consider your comfortability with alternatives to touch, such as holding pillows, cushions, props, weighted blankets.

Know that you can decline touch at any time - including during the session, even when you have already consented.

Discuss touch that may be required for safety, for example to stop you from falling, help you stand up to walk to the bathroom.

Discuss a hand signal that could indicate you would like touch and a hand signal that you do NOT want touch.

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Best Practices for Practitioners

Relating to Consent

Obtain written consent. With clients permission, consider recording (audio, visual) the medicine session as it may be helpful to review with the client at a later time. Keep full, unedited recordings with the secure, confidential client medical record.

State explicitly there will be no sexual touch. 

Set boundaries ahead of time and review the distinction between sexual and non-sexual touch in the preparatory meetings. Plan to review the client's experience of touch afterward the medicine session is complete.

Remind clients that informed consent in therapy, including touch, is continuous and ongoing and can be withdrawn at any time.

Discuss the risks and benefits of therapeutic touch. 

In the preparation sessions leading up to the ceremony, it can be useful to discuss clearly and practice feeling into what sort of touch feels comfortable and appropriate. Notice what sensations, thoughts, emotions arise with touch without medicine

Practice the signals for requesting touch and refusing touch.  

Emphasize that it is entirely their decision and they can say no to touch even if they have requested touch prior to the session.

Remind clients that touch to ensure safety will be provided automatically - and discuss what that might look like, such as stopping them from falling, assisting them to walk to the bathroom.

Discuss where the client would like you to be situated during their session (i.e., right beside them or farther away)?

If you are trained in energetic therapies describe what energetic touch may look like. (i.e., 

sweeping your hands over their bodies).

Discuss alternatives to touch with the practitioner, such as props (teddy bears, pillows), using a pillow as a barrier to hand holding (placing a pillow over the client’s hand and yours over the pillow), having the client holding their own hand.

If the client changes their mind during the medicine, we err on the side of caution. For example, if the client says they want touch, and changes their mind once they have taken the medicine, the request to avoid touch will be honoured. If the client says they do not want to be touched but request touch during the medicine, gently remind them of the agreement and offer other forms of closeness and support.  

Relating to One’s Own Capacity as a Practitioner

Understand both (1) external guidelines, rules, and standards of care as well as (2) our own internal motivations, semi- or unconscious fears and desires that could impact the ways in which touch is approached and negotiated (Taylor, 2019).

*Different healthcare professions will have their own guidelines which will supercede recommendations here

The practitioner does not direct touch, rather it is guided by the client. Always understand the “why” or rationale behind your touch so that it is not coming from the practitioner’s personal motivations, unmet needs; psychedelic therapy sessions have been found to catalyze strong feelings in clinicians, even among those with the best intentions, which can increase the risk of boundary violations (McLane et al., 2021).

Developing astute judgement and skillfulness in our practice comes from careful examination of motives, behaviours, and the ethical possibilities of touch in psychedelic therapy. Furthermore, cultivating an understanding of the power one holds as a practitioner and of the damage that can be done when boundaries are crossed can prevent the exploitation of clients and their trust (Austin et al., 2006). 

“Ethical action takes place in community” (Austin, 2007, p. 85). Being ethical and responding to the question “How should I act?” is grounded in relations with others. There is a need for ongoing dialogue to address ethical questions; attentiveness to the ethical needs of a situation is a skill and requires direct efforts to be learned, cultivated, and maintained. 

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References & Resources:

WAIT - Why Am I Touching?

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Austin, W., Bergum, V., Nuttgens, S., & Peternelj-Taylor, C. (2006) A re-visioning of boundaries in professional helping relationships: Exploring other metaphors. Ethics & Behavior, 16(2), 77-94. Retrieved from: 

https://www.tandfonline.com/doi/abs/10.1207/s15327019eb1602_1?casa_token=JtTbYw8b-lkAAAAA:9AKQtZyVIALwTA6vZuU4vCVUA6aNeZwb8X3Tw6QB5tdoUQ6LSBAs8dkBpudwiZBLf0YsRZdbovUlmEw

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Haden, M. (2020) Manual for psychedelic guides. Kyandara Publishing 

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Leite, M. (2021) Can ethics and sexual abuse allegations create backlash and impact the current psychedelic renaissance? Chacruna Institute for Psychedelic Plant Medicines. Retrieved from: https://chacruna.net/ethics-sexual-abuse-allegations-backlash-psychedelic-renaissance/

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McLane, H., Hutchison, C., Wikler, D., Howell, T., & Knighton, E. (2021) Respecting autonomy in altered states: Navigating ethical quandaries in psychedelic therapy. Journal of Medical Ethics. Retrieved from: https://blogs.bmj.com/medical-ethics/2021/12/22/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy/

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Taylor, K. (2019) Our vulnerabilities to unethical sexual behavior. Chacruna Institute for Psychedelic Plant Medicines. Retrieved from: https://chacruna.net/our-vulnerabilities-to-unethical-sexual-behavior/

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Special thanks to those who contributed their time to create/edit/give feedback on this offering to the community:

Michelle Brewer
Michelle Gagnon
Pamela Kryskow