Psychedelics-assisted psychotherapy: Experiences with the limited medical use of LSD, MDMA, and psilocybin in Switzerland

Since the late 1990s psychedelics have experienced a renaissance and attracted increasingly more attention internationally. There are an increasing number of scientific studies investigating the possibilities and risks of psychedelics-assisted therapy (PAT). Since 2014 lysergic acid diethylamide (LSD), N-methyl-3,4-methylenedioxyamphetamine (MDMA) and psilocybin have been used therapeutically on a case by case basis in the context of exemption permits issued by the Swiss health authorities (Federal Office for Public Health). In the past 9 years, based on this legally anchored possibility for limited medical use of these substances, more than 1000 individual case permits have been issued to approximately 60 therapists and an estimated 2000-3000 treatments with psychedelics have been carried out. The aim of this article is to provide an insight into the current treatment practice of PAT in Switzerland. Application procedures, indications, considerations on the transdiagnostic perspective, and the design of the treatment framework and setting, such as the phases of a PAT, psychotherapeutic embedding or the choice for an individual or group setting, are discussed. The integration of PAT into psychotherapy could open up new possibilities for the treatment of mental disorders. The experiences in Switzerland could provide impulse for the international practice of PAT. At the same time, the situation in Switzerland is also in constant development. Due to the increasing interest in PAT, new challenges arise. The continuous education of therapists is also addressed in this context. Of central importance are ethical standards and measures for quality assurance, for example through peer exchange and networking in intervision, supervision and participation in advanced training courses but also systematic documentation of PAT through questionnaires or patient registers.