Psychedelic-assisted therapy: a survey on the clinical methods of Swiss physicians

Beichmann and colleagues situate the study in the rapid growth of interest in psychedelic-assisted therapy and in the limited reporting of therapeutic methods in earlier clinical trials. They note that, although some countries have introduced regulated access pathways, it remains unclear how psychedelic-assisted therapy is actually practised in everyday clinical settings, because legal restrictions and highly standardised trial designs make real-world practice difficult to study. Switzerland is presented as a particularly informative case because physicians can obtain case-by-case exemptions from the Federal Office of Public Health to treat patients with psilocybin, LSD or MDMA within a medical framework. The authors say the study aimed to describe current psychedelic-assisted therapy practice in Switzerland, including practitioner backgrounds, patient characteristics, therapeutic techniques, treatment structures, and perceived benefits and challenges. They frame the project as a way to bridge the gap between controlled research and naturalistic clinical care, and to provide information relevant to clinicians, researchers, policymakers and training efforts. The paper is an anonymous survey of Swiss physicians who are legally providing psychedelic-assisted therapy, making it a practice-based overview rather than a treatment efficacy study.

The researchers conducted an anonymous online survey using REDCap between February 2024 and November 2024. Recruitment took place through advertisements at meetings of Swiss PAT professional organisations, direct email contact with registered members, and the authors’ professional networks in German-, French- and Italian-speaking Swiss PAT associations. The survey could be completed in English, German or French, and took about 60-90 minutes. Physicians were eligible if they had ever treated a patient with psychedelic-assisted therapy under the Swiss limited medical use law. Physicians whose involvement was limited to research, supervision or training, or who practised outside the Swiss legal framework, were excluded. The questionnaire contained multiple-choice items, open-text questions, rankings, Likert scales and continuous scales. It covered practitioner training, theoretical orientation, personal psychedelic experience, patient characteristics, indications and contraindications, preparation and integration, setting, body contact, substances and dosing, therapeutic processes, perceived predictors of success, adverse effects, and views on personal psychedelic experience among therapists. The survey items were created specifically for this study, informed partly by earlier literature and the authors’ own clinical experience. The survey was not formally validated, and no formal pilot testing was conducted in the target population, although two student volunteers checked it for programming errors. Analyses were descriptive only, conducted in R and RStudio. Qualitative free-text responses were used as illustrative examples. The manuscript states that the authors consulted the STROBE statement for cross-sectional studies when preparing the report.

Forty-one physicians began the survey, and 21 completed it fully, leaving a completion rate of about half. Most respondents answered in German, and almost all reported combining PAT with conventional psychotherapy. On average, respondents had around 20 years of experience in psychotherapy. Most worked in private practice or outpatient settings, with fewer in hospitals or shared practices. Many said they had begun practising PAT through contact with colleagues, their own psychedelic experiences, reading the literature, or exposure during medical training. Theoretical orientation differed between conventional psychotherapy and PAT. For conventional psychotherapy, psychoanalytic/psychodynamic, body-oriented and cognitive behavioural approaches were most common. For PAT, body-oriented, psychoanalytic/psychodynamic and eclectic approaches were most prominent. Only 11 of 41 respondents said their PAT approach was fundamentally different from their conventional psychotherapy approach. Most respondents reported personal psychedelic experience, and nearly all said they took part in intervision or supervision focused on PAT. Respondents treated PAT patients for a wide range of conditions. The most commonly cited psychiatric indications were depression, anxiety disorders, PTSD, OCD, complex PTSD and substance use disorders, with end-of-life distress, eating disorders and psychosomatic disorders also frequently mentioned. Among somatic indications, chronic pain and cluster headaches were most common. The ranking of primary psychiatric diagnoses showed moderate agreement between respondents, with Kendall’s W = 0.41, p < .001. For patients with prior psychedelic use, recreational use was the most commonly reported context, followed by personal development and therapeutic use. Schizophrenia was the most frequently named contraindication, along with an unreliable therapeutic relationship, serious somatic illness or pregnancy, unrealistic expectations and unstable life circumstances. Treatment structure varied, but patients received an average of 5.1 substance sessions over the course of therapy, with sessions commonly spaced about 3 months apart. Most physicians provided preparation sessions, usually two to five before dosing, and all respondents provided integration sessions after the psychedelic experience. Integration most often involved psychotherapeutic conversation, but also included writing, drawing, body practices, music and meditation. Respondents described integration as helping patients stabilise, make sense of the experience, and transfer insights into everyday life. In terms of setting, most respondents always promoted a preparatory mindset or intention before dosing. About half offered only individual PAT, while others used both individual and group formats. Individual sessions usually involved the physician alone or with one co-therapist; group sessions more often involved two therapists, though some used more. Individual dosing sessions usually took place in the practice or clinic, whereas group sessions were also often held in rented spaces with access to nature. Nearly all respondents prepared the room specially, most commonly with music, food and drink, silence, dimmed lights and flowers. Most patients lay on a mattress or bed, and many sessions included a period of silent introspection, often with eyeshades. Music and body contact were both common. Most respondents always played music during psychedelic sessions, and most encouraged at least some use of eyeshades. The majority believed physical touch was an important tool in PAT, and reported using it more often in PAT than in conventional psychotherapy. Common forms included holding the patient’s hand, placing a hand on the shoulder, mediated contact such as blankets or pillows, and holding the head. The main reasons for touch were to support patients during difficult experiences and to help them feel safe; some also saw it as helping catharsis or insight. The most common reasons not to touch were patient refusal, concern about sexual feelings, a history of sexual abuse, and the physician’s own boundary concerns. Almost all respondents said they discussed consent to touch before sessions, and most reconfirmed consent before any intervention. The substances used were psilocybin, MDMA and LSD, with psilocybin most common. The extracted text clearly reports use frequencies, but the section on choosing substances is cut off before the full list of the most important selection factors is visible. In individual PAT, the therapeutic processes most often observed were confronting personal issues, life review and integration, reflection on the psychedelic experience, connectedness with self and world, and developing new perspectives. When asked what mattered most, respondents most often chose connectedness with self and world, followed by life review/integration and processing traumatic experiences. In group PAT, the most often observed processes were instillation of hope, interpersonal learning and group cohesion; the most important factors were interpersonal learning, reduced loneliness in suffering, and corrective recapitulation of early family patterns. Respondents identified a strong therapeutic relationship as the key predictor of successful outcomes, followed by favourable patient characteristics, deep psychological insight and a profound psychedelic or mystical experience. Commonly cited patient characteristics included commitment to therapy, self-awareness and certain personality traits. The most frequent adverse effects were loss of orientation in time and space, feeling too cold, anxiety and nausea. Delirium, suicidality, self-harm and loss of eyesight were rarely reported. Almost all respondents kept emergency medication available, most commonly benzodiazepines and antipsychotics, and they reported using rescue medication in 2.43% of sessions on average, mainly for anxiety or panic. Most respondents believed physicians should have their own psychedelic experience. The open-text explanations suggested that this was seen as helping physicians understand the subjective effects, risks and limitations of the drugs, although a minority argued that personal experience was not necessary. The authors also report that the range of dosages used was wide, but they do not clearly give a full dosing table in the extracted prose.

The authors argue that the survey shows a highly diverse and individualised practice of psychedelic-assisted therapy in Switzerland. They emphasise that treatment is commonly embedded in broader psychotherapeutic care, that preparation and integration are routine, and that group work, body-oriented approaches, and the use of touch are more prominent in this real-world setting than in many research trials. They interpret the frequent emphasis on therapeutic relationship, preparation, integration and setting as evidence that PAT in Switzerland is practised as a structured psychotherapy rather than simply as drug administration. Compared with earlier research and clinical trials, the authors say Swiss practice differs in several ways. The number of substance sessions is higher than is typical in most trials, which they attribute to the Swiss legal context, the treatment-resistant populations being seen, and the fact that many clinicians consider PAT part of ongoing psychiatric or psychotherapeutic care. They also note that group PAT has historical precedent and may offer benefits, although most contemporary studies focus on individual treatment. They suggest that therapists’ personal psychedelic experience is widely viewed by respondents as useful for understanding the treatment, while acknowledging that some clinicians disagree. The authors highlight several limitations. The findings are based entirely on self-report and retrospective recall, which makes them vulnerable to recall bias and social desirability bias. The completion rate was low, with about half of respondents dropping out. The survey instruments were original and not formally validated, and there was no formal pilot test in the target population. The physicians also varied greatly in how many patients they had treated, so some answers may have been based on limited experience. The authors additionally note that the Swiss legal and healthcare context is unusual, which substantially limits generalisability to other countries. They further discuss access and implementation issues. Because treatment is often financed by patients themselves, financial barriers may shape access and the types of patients who receive PAT. They interpret the overall pattern of practice as occurring within ordinary ambulatory psychiatric settings in Switzerland rather than in a fringe context, but they caution that the model is highly specific to Swiss regulation and health-system organisation. Overall, they present the survey as a basis for further discussion about clinical methods, training and future integration of psychedelic therapies.

The authors conclude that their survey offers a broad picture of psychedelic-assisted therapy as it is being practised by Swiss physicians under the Federal Office of Public Health’s limited medical use framework. They state that the findings show substantial variation in theoretical orientation, treatment methods, substances, dosing, patient groups, settings and therapeutic techniques. They present Switzerland’s regulatory model as an instructive example for understanding how psychedelic therapies may be implemented in real healthcare settings, while stressing that the findings should be viewed as context-specific and not directly generalisable to other countries.