Introduction - Purpose of Document:‍

1. The importance of addressing ethical breaches in the context of psychedelic-assisted therapy.
   It is essential that people working with psychedelics in a therapeutic container stay at the highest ethical integrity - and yet there are transgressions in this community. Previously posted documents offer guidance to reduce the likelihood of transgressions. This document’s purpose is to provide some guidance if a transgression occurs. It is a living imperfect document. This means that our community (including you) will continue to read it over time and improve as a gift to everyone. Your thoughtful, compassionate feedback is welcome. Feedback includes tangible ideas on how to improve, not commentary on deficits. Please suggest solutions, better wording, language or frameworks etc. These are welcome.
   
2. We encourage you to lean into any discomfort as you read the document. Growth can happen in discomfort. Growth happens when we widen the blinders and see things we did not see before. Growth happens when we learn from our mistakes and the mistakes of the past. As a community we all can do better if we lean in.
3. The importance of mapping a process that creates pathways back to connection and community for the parties named in the complaint where possible.
   This document functions as preparation for inevitable future distress in our community and offers a roadmap for embracing these stressors as a way to build a stronger, more connected and compassionate community that calls one another in, rather than calling one another out. We acknowledge that human beings are imperfect and as such we ALL have blind spots; we commit to creating a safe place for all people to be held with compassionate care as they engage in a supported reflection process aimed at reparation and where possible, the rebuilding of relationships.

4. Definitions of words used in this document:
   

Apology: An apology, in the context of psychedelic-assisted therapy, is a formal expression of acknowledgment and regret by a practitioner or practitioner for any real or perceived harm, distress, or ethical breach experienced by the client.

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Client/Patient: In the context of psychedelic-assisted therapy, "client" and "patient" are often used interchangeably to describe the individuals seeking therapeutic support and guidance from practitioners. The choice of term may depend on the therapeutic setting and local regulations.

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Complaint: In psychedelic-assisted therapy, a complaint refers to an expression of dissatisfaction or concern from a client, patient, or involved party regarding the behaviour, practices, or actions of a practitioner or practitioner. Complaints are taken seriously and should be addressed ethically, transparently and professionally.

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Confidentiality: Confidentiality is a core ethical principle in psychedelic-assisted therapy. It entails the responsibility of practitioners and practitioners to maintain the privacy and confidentiality of client or patient information and experiences unless required by law or ethical standards to do otherwise.

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Ethical breach: An ethical breach in psychedelic-assisted therapy refers to the violation of established ethical guidelines and principles, such as breaches of confidentiality, inappropriate conduct, or unsafe practices by a practitioner or practitioner. Ethical breaches require addressing to uphold professional standards.

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Ethical oversight body: An ethical oversight body is an organization or regulatory authority responsible for establishing and enforcing ethical guidelines, standards, and best practices within the field of psychedelic-assisted therapy. It ensures that practitioners adhere to ethical principles.

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Practitioner: A practitioner in psychedelic-assisted therapy is a trained and qualified individual who administers or guides psychedelic experiences to clients or patients within ethical and legal boundaries. This term can include practitioners, facilitators, or healers.

• Above ground practitioner: A practitioner who is registered with a licensing body, has completed certified training, has been evaluated by their peers and mentors for competency, maintains insurance coverage, and who legal complaints can be filed.
• Underground practitioner: In the context of psychedelic-assisted therapy, "underground" typically refers to practices, practitioners, or experiences that occur outside legal and regulatory frameworks. It often implies a lack of oversight and accountability.
  

Psychedelic-assisted therapy: Psychedelic-assisted therapy is a form of therapy that incorporates the use of psychedelic substances, such as psilocybin or MDMA, to enhance the therapeutic process. It involves a trained practitioner guiding and supporting the client through their psychedelic experiences to achieve therapeutic goals.

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Self-reflection: Self-reflection in psychedelic-assisted therapy refers to the practice of practitioners critically examining their own actions, behaviours, and ethical considerations in their work. It is a fundamental process for maintaining ethical integrity and personal growth.

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Supervision: Supervision is the practice of experienced practitioners or professionals overseeing and offering guidance to less experienced practitioners, trainees, or practitioners. It serves to ensure ethical and safe practices, provide mentorship, and support professional growth.

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5. What is an ethical breach?
   Ethical breaches include transgressions against values within the Code of Ethics including (a) Embodiment of Your Practice, (b) Integrity, (c) Respect and Care, (d) Building Capacity for Consent, (e) Honouring Diversity and Supporting Social Justice, (f) Competence and Life-Long Learning, (g) Creating Honouring Processes, and (h) Honouring Peoples Bodies and Boundaries. Other guiding principles for ethical breaches include respect for autonomy, beneficence, justice, and nonmaleficence 

6. Where Ethical Breaches Can Happen:

Dual Relationships:
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Definition of a Dual Relationship: A dual relationship is when you have two or more distinct kinds of relationships with the same person. This means having a relationship with the individual that is outside the established therapeutic context, for example, where the individual is also a relative, friend, coworker, or part of your social group.

Avoid entering into dual relationships as they can lead to impaired professional judgement and have unavoidable power dynamics.

In cases where there is an unavoidable dual relationship such as working in the context of a  community, give special attention to issues of confidentiality, trust, communication, and boundaries. Always seek supervision in these cases to remove any chance of transgression. Recognize that there can be nuance around dual relationships and that they can be navigated ethically as long as there is strong communication and awareness around them as well as systems in place should any transgressions arise.

Please see Best Practices for Psychedelic Practitioners for a more fulsome discussion and guidance.

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Touch:

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)

Though certain ethical guidelines may be clear (i.e., no sexual touching, no touching the chest, no touching the groin/genitals, no touching the buttocks), 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.

Consent and agreements of ‘No touch’ prior to the start of a medicine session are always prioritised to any touch asked for under the medicine.

If a ‘Yes’ prior to medicine changes to a ‘No’ once the medicine session starts, the ‘No’ takes priority.

Please see How to Navigate Touch in Therapy for a more fulsome discussion and guidance.

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Examples of Transgressions:

‍Sexual misconduct: 

• sexual intercourse or other forms of physical sexual relations between a practitioner and a patient/client
• touching, of a sexual nature, of a patient/client by a practitioner
• behaviour or remarks of a sexual nature by a practitioner towards a patient/client

Transgressions of a sexual nature may involve:

• inappropriate comments or gestures, where a practitioner:
• makes sexually suggestive or seductive comments
• makes unnecessary comments about sexual relationships or sexual orientation
• makes sexually insulting or offensive comments or jokes
• asks a patient/client on a date
• gives unwanted hugs or kisses
• any other sexual contact that happens between a patient/client and a practitioner

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Privacy and Record Keeping: 

All records must be maintained at the highest security as would be expected of your medical doctor or other healthcare provider. No exceptions. These records are only available to the patient and their very tight circle of care. 

You must receive in writing permission from the client/patient prior to sharing any therapy records and the permission should specify what kind of information is allowed to be shared.

If you or your team cannot maintain this level of integrity, no participant identifiers may be attached to your records.

If your records have been breached, the patient attached to the record must be informed immediately. Additionally, we suggest seeking supervision to review and reflect on how the breach occurred and what steps need to be taken to ensure the breach is not repeated.

To be clear, privacy breaches in healthcare can and often lead to termination - this is a big deal so please ensure that you understand what ethical record keeping entails and seek guidance if you are unsure. 

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Accurate Information:

Education and information about psychedelics is an important piece of informed consent

Practitioners are obligated to disclose information that a reasonable person would want to know about the treatment at hand. This generally includes disclosure of the nature of the therapy or treatment, the risks, the potential benefits, and what alternatives might be available (Smith & Sisti, 2020)  

Practitioners hold a role in helping patients to synthesize and critically evaluate information they encounter or obtain on their own. Additionally, practitioners are in a position to directly interpret and educate even when trying to avoid appearing in favour of or against psychedelic practices. For example, addressing misinformation relating to psychedelics being a “magic bullet” without awareness of potential challenging experiences or surfacing of avoided memories (Pilecki et al., 2021)

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To the Psychedelic Community:

If you are an underground practitioner you are working outside the legal system. You must operate at the same high level of ethics and integrity as you would in a legal system.

Ensure that you are in an accountability group of your peers that includes mentors who are much more experienced than you and colleagues who fully understand best practices, safety, and service. Do not work alone. Do not work in silos. Appreciate that being in relationship and conversation with other practitioners expands and strengthens your practice.

If you have caused harm or are accused of causing harm please lean in to repair and restoration. This document is designed to assist in that process. Regardless if you think you have done harm, the aggrieved person is to be believed and a process of repair must be initiated in good faith.

If you are a person looking to work with an underground practitioner please fully understand you are working outside the protections of the law. The Psychedelic Association of Canada has posted this document to help you find a practitioner of the HIGHEST integrity. If the person(s) you are hoping to work with does not check all the boxes, walk away. The risk is not worth it. There are people out there who are poorly skilled, with big egos, little experience, and who are opportunistic who may cause harm to you. There are high integrity underground practitioners - those are the ones you want to work with.

If you are a person looking to work with an above ground practitioner - MDs, Nurses, Registered Psychologists, Registered practitioners, etc. and you are harmed by one of these professionals, you can make an official complaint through their licensing body. See list of regulatory agencies at the end of this document.

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Responding to Ethical Breaches in the Underground

How to Respond to an Ethical Breach against yourself

1. Recognize the signs by educating yourself about ethical guidelines and red flags indicating ethical breaches (see How to Find an Ethical Therapist as a starting place
   

2. Seek Support:
   Reach out to trusted friends or professionals for emotional support and guidance.
   

3. Document and Reflect: 
   1. Make notes of what you feel the breach is. Keep this for your records.
   2. Read through the “Code of Ethics” and “Best Practices for Psychedelic Therapists”
   3. Use that as a guide to show the transgressions. For example: “As per xxx in the PAC Code of Ethics - this behaviour xxxx contravenes the Code of Ethics.”
   4. Work with a trusted person to fine tune the above. Ensure you are dealing with your complaint. You are not there to deal with the complaints of others. That is their concern only. 
   5. Determine and request what remedy you are seeking. Examples may include: an apology, a reconciliation circle, a legal remedy, a monetary refund, etc. 

4. Approaching the practitioner that you worked with your document. 
   1. Bring a trusted witness with you to present your concerns or cc a trusted witness in  your email.
   2. Clearly include what remedy you are seeking. 
   3. Clearly indicate a timeline to meet and begin the process.
   4. Suggest a neutral professional facilitator for the process.

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How to Respond to an Ethical Breach as a Practitioner

• Read or listen to the complaint fully, with an open mind.
• Lean in with the question, how would I want to be treated if I was the complainant?
• Bring in at least one trusted colleague or support person who will be an objective voice of reason for you. Not someone who will simply echo your words.
• If you are part of a consult/accountability group, bring your situation to the highest level thinkers and person’s of integrity in that group. 
• If you do not have an accountability group or colleagues you can turn to, try speaking with a representative from your local psychedelic society. You can find a list of psychedelic societies around the world here.
• Self-Assessment: Reflect on your professional conduct and acknowledge any breach.
• Ensure the complainant feels safe in the process.
• Ensure you feel safe in the process. 
• Client Welfare: Ensure the safety and well-being of clients by addressing the breach promptly.
• In the case where you are not immediately aware of how best to respond, at least let the complainant know you received their complaint and will get it as soon as possible.

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How to Prevent Ethical Breaches as a Community

• Develop a community code of conduct.
• Provide a system to the community that can efficiently and proactively receive feedback
• Promote awareness of ethical standards within the community.
• Practitioners should contribute to a Codes of Ethics.
• Practitioners should sign pledges to abide by Codes of Ethics.
• Practitioners should be part of consult and accountability groups.
• Practitioners should create local based circles of reconciliation to hear and facilitate restorative justice. 
• Practitioners should meet regularly to discuss best practices and discuss difficult situations.
• Create a white-label system that any psychedelic community out there can use.
• Community Support: Offer resources, workshops, and discussions on ethical topics to enhance community ethics.
• Create a community atmosphere that incentivises people to look out for one another and to lean in instead of lean out when things get difficult.
• Emphasise other transformative state-shifting technologies aside from psychedelics (eg. breathwork).
• Stay up to date on the latest research around what populations might not be suited for psychedelic treatment interventions.

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How to Respond to Ethical Breaches as a Community

• Create a local “Circle of Elders” made up of diverse practitioners:
• Who are well respected
• Have more than a decade of experience
• Who have wise mentors more experienced than themselves.
• Who have high integrity
• Are visionary problem solvers
• Receive concerns from aggrieved patients/clients ensuring
• The complaint is objectively written
• Is clear in the remedy sought
• The complainant has solid support
• The practitioner has solid support
• The process is started at the soonest opportunity
• Ensure that the remedy is agreed upon by both parties and followed through with
• Ensure that both parties now agree “The process is now complete”
• Debrief and quality improve after any process to discuss what went well and what could be improved,
• Share learnings with the community so that future transgressions can be avoided.

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Responding to Ethical Breaches in the Above Ground / Regulated Professionals: 

The following are the professional organizations that will receive your complaint for legal professional:

Physicians and Surgeons (Provincial & Territorial)

Registered Nurses, Psychiatric Nurses, and Licensed Practical Nurses (Provincial & Territorial)

Registered Psychologists (Provincial & Territorial)

Registered Counselling practitioners and Psychopractitioners (Provincial & Territorial)

Registered Social Workers

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Concluding Thoughts:

• As a community we are all responsible for ethical behaviour. Ongoing discussion and collaboration is encouraged and needed in the realm of ethics in psychedelic therapy.
• Despite the difficulty of dealing with transgressions, we must lean in to resolve transgressions in this space so that people can move towards wholeness.
• If we are to work in this space we are responsible to work at the highest integrity only.
• We must not engage in this work for accolades or ego.
• If we have caused harm we must engage in reconciliation.
• Collective efforts of individuals, practitioners, and communities can help maintain the integrity of the field.
• To conclude, we are a society and planet in need of healing and returning to a whole, healthy place. It is essential that people working with psychedelics in a therapeutic container stay at the highest ethical integrity. This living, imperfect document’s purpose is to provide some guidance if a transgression occurs. We acknowledge that human beings are imperfect and as such we all have blind spots; we commit to creating a safe place for all people to be held with compassionate care as they engage in a supported reflection process aimed at reparation and where possible, the rebuilding of relationships.

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Resources

PROFESSIONAL FACILITATORS:

*If you or your community contacts would like to be added here, please email Dr. Pamela Kryskow at pkryskow@psychedelicassociation.com

Dr. K. A. Dawson, R. Psych. (CPBC #1566)

Dawson Psychological Services, Inc.

1790 Barrie Road

Victoria, BC V8N 2W7

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Cell Phone: 250-899-1794

info@dawsonpsychologicalservices.com

www.dawsonpsychologicalservices.com

www.psychologicalhealth.life

RESOURCES - Transformative Justice, Community Accountability, Survivor Resources
Our process is being guided by the formidable, on-the-ground work of IBPOC and LGBTQIA2S+ in Transformative Justice (TJ) and community accountability, as well as Disability Justice movements, and we are incredibly grateful and humbled by the knowledge and wisdom of the teachers who have come before us. Listed below are resources from which we have gathered wisdom, including resources for survivor support. We call on community members who may be unfamiliar with these processes to consider the following resources, and to respectfully cite and acknowledge any materials that you use in your own practices, going forward. 

Survivor Support Services :

VictimsLinkBC 

British Columbia Male Survivors of Sexual Abuse

Solidarity for Survivors

Psychedelic Support - Network of Professional Integration Practitioners 

HealthLink BC - Mental Health Support Resources

BetterHelp - Network of Mental Health Professionals

Psychedelic Survivors

Psychedelic Survivors Community Circle

Ethical Psychedelic International Community

Shine Collective

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Resources :

Beyond Survival: Strategies and Stories from the Transformative Justice Movement, by Ejeris Dixon; Leah Lakshmi Piepzna-Samarasinha (book)

Addressing Violence in the Psychedelic World Part 2: Healing from Community Harm (video recording)

Emergent Strategy: Shaping Change, Changing Worlds, by Adrienne Maree Brown (book)

Pleasure Activism: The Politics of Feeling Good, by Adrienne Maree Brown (book)

Alyssa Storrs - Disability Justice & Spiritual Direction 

Regulatory Agencies :

Physicians and Surgeons (Provincial & Territorial)

Registered Nurses, Psychiatric Nurses, and Licensed Practical Nurses (Provincial & Territorial)

Registered Psychologists (Provincial & Territorial)

Registered Counselling practitioners and Psychopractitioners (Provincial & Territorial)

Registered Social Workers

In Text References :

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/

Pilecki, B., Luoma, J., Bathje, G., Rhea., J., & Narloch, V. (2021) Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal; 18(1): 1-40. Doi: 10.1186/s12954-021-00489-1

Smith, W., & Sisti, D. (2020) Ethics and ego dissolution: The case of psilocybin. J Med Ethics; 0: 1-8. Doi: 10.1136/medethics-2020-106070

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ACKNOWLEDGEMENTS FOR THEIR CONTRIBUTIONS

Dr. Pamela  Kryskow, MD

Michelle Brewer

Michelle Gagnon, PhD(c)

Tracy Lowe

Michael Oliver

Lindsay Billingsley, MSW