Is Personal Experience Essential for Effective Psychedelic Therapists?: The Challenges of Small, Accumulating Therapist Effects.

Many authors assert that those who provide psychedelic-assisted therapy (PAT) likely benefit from having personal experiences with psychedelics (PEP) as part of their training. Meta-analytic results confirm advantages of experiential learning in other forms of training as well. Potential PAT clients, especially those who identify as members of underrepresented groups, report that PEP is important to them in their choice of guides. Establishing PAT's efficacy will require more trained professionals for generating appropriately powered clinical trials. Despite these rationales for PEP for trainees, prevalent legal prohibitions limit access to psychedelics, preventing trainees from obtaining experiences that many potential clients deem important. A randomized clinical trial comparing outcomes in those trained with PEP to those trained without the experience has intuitive appeal. Nevertheless, a close look at challenges related to design suggests that a definitive experiment would require more resources than almost every previous study of PAT or therapist effects. (Based on effect size estimates from other therapist effects, power analyses reveal that an experiment with 80-160 participants could offer meaningful data. An ideal design would require 80 therapists treating 30 clients each.) Underpowered designs, however, could lead to serious misinterpretations that would suggest that PEP fails to provide advantages. Given the severity of symptoms targeted by PAT, the current need for treatment providers (especially members of underrepresented groups), the rarity of serious negative consequences in supervised drug administration trials, and the low potential for PEP-induced symptoms of dependence, permitting trainees access likely would create more positives than harms.