Dosing and Therapeutic Conduct in Administration Sessions in Substance-Assisted Psychotherapy: A Systematized Review
This systematised review of 82 sources synthesised published guidance on substances, dosages, session structure, music and in-session therapeutic conduct for administration sessions with serotonergic psychedelics and entactogens. It concludes that evidence is largely anecdotal and non-rigorous, leaving essential components of therapeutic interventions tentative and in need of systematic empirical investigation.
Authors
- Stephen Bright
Published
Abstract
While the potential of serotonergic psychedelics and related substances as adjuncts in substance-assisted psychotherapy (SAPT) has been investigated for the treatment of several disorders, evidence for the appropriate therapeutic conduct in administration sessions is sparse. In this article, we discuss the current evidence for best therapeutic practice during administration sessions with serotonergic psychedelics and entactogens as adjuncts to psychotherapy. We conducted a systematized review of the literature following PRISMA guidelines. PsycINFO, MEDLINE, and Cochrane Library databases were searched. Clinical trials, treatment manuals, study protocols, qualitative studies, case studies, descriptive studies, opinion papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. The final synthesis included k = 82 sources. Information about substances, dosages, number of administration sessions, issues that are common for clients, different types of experiences, music, and therapeutic conduct was summarized, compared, and critically discussed. The effects different therapeutic models, methods, techniques, and more complex interventions each have on the therapeutic outcome have not been investigated by means of rigorous research. Most of the available evidence we retrieved was anecdotal limiting any conclusive statements regarding appropriate therapeutic conduct during administration sessions. Consequently, essential components of therapeutic interventions remain largely tentative, necessitating systematic investigation.
Research Summary of 'Dosing and Therapeutic Conduct in Administration Sessions in Substance-Assisted Psychotherapy: A Systematized Review'
Introduction
Psychedelics have a long anthropological history and renewed contemporary interest across ritual, recreational, underground therapy and clinical settings. Thal and colleagues note that while several serotonergic psychedelics and entactogens (for example psilocybin, LSD, ayahuasca, MDMA) are being investigated as adjuncts to psychotherapy for conditions such as addiction, anxiety, obsessive–compulsive disorder and treatment‑resistant depression, guidance about how therapists should conduct the administration session itself remains sparse. The authors highlight that therapeutic outcomes in substance‑assisted psychotherapy (SAPT) are shaped by the pharmacology of the substance, client dispositions and subjective experiences during dosing, and by preparatory and integration work, yet practical detail about in‑session conduct is often anecdotal or under‑reported in modern trials. This systematised review aims to summarise reported practices for the administration stage of SAPT. Specifically, Thal and colleagues set out to extract information about which substances are used as adjuncts, typical dosages, the number of administration sessions across models, common client and therapist issues during dosing, the types of subjective experiences elicited, and recommended therapeutic conduct during administration sessions. The paper is positioned as the third in a series synthesising Western psychotherapeutic paradigms for SAPT developed since the 1950s, building on prior reviews of preconditions and preparation-stage practices.
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Thal, S. B., Wieberneit, M., Sharbanee, J. M., Skeffington, P. M., Bruno, R., Wenge, T., & Bright, S. J. (2023). Dosing and Therapeutic Conduct in Administration Sessions in Substance-Assisted Psychotherapy: A Systematized Review. Journal of Humanistic Psychology. https://doi.org/10.1177/00221678231168516
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