PSI Psychedelic Practitioner Misconduct Typology

Psychedelic Practitioner Misconduct Typology

Psychedelic Safety Institute’s

Psychedelic Practitioner Misconduct Typology

Contents

Contents

Background: The History of Misconduct in Psychedelic Contexts

Purpose

Scope

Intrinsic Properties of Psychedelics May Increase Risk for Misconduct

Misconduct Typology

Terminology

Key Assumptions

Categories of Misconduct By Psychedelic Practitioners

Category 1 Misconduct: Egregious Misconduct

Category 2 Misconduct: Significant Ethical Violations

Category 1 Misconduct

Sexual Misconduct:

Financial Exploitation:

Fraud

Physical Abuse: Violation of Consent and Coercion: Abandonment: Category 2 Misconduct

Verbal, Psychological, and Emotional Misconduct

Unsafe Physical Environment

Breach of Confidentiality:

Negligence:

Discrimination:

Appropriation:

Blurred Boundaries & Dual Relationships

Harmful Group and Social Dynamics

References

Background and History References

Risk Factors References

Misconduct Typology References

Background: The History of Misconduct in Psychedelic Contexts

While psychedelic-assisted therapies and spiritual practices hold immense potential for healing, historical evidence shows that psychedelic spaces have also been sites of serious ethical violations Across different cultural and therapeutic contexts, certain practitioners have leveraged altered states of consciousness to manipulate, coerce, or exploit participants

The Role of Spiritual Authority in Psychedelic Misconduct

Certain practitioners establish spiritual hierarchies that allow them to exert undue influence over participants Research has identified:

● Multiple documented instances of psychedelic practitioners creating problematic spiritual hierarchies, positioning themselves as gatekeepers of wisdom or healing (Labate & Cavnar, 2014; Fotiou, 2020).

● Historical analysis reveals patterns of exploitation by figures claiming spiritual authority (Kent, 2019).

● Psychedelics can amplify transference and projection, causing practitioners to absorb participants' idealizations and see themselves as uniquely insightful or powerful This ego inflation can reinforce guru-like behaviors and foster cultic social dynamics, where their authority is rarely questioned. Such environments increase the risk of harm and misconduct going unnoticed or unreported (Evans and Adams, 2025).

While these phenomena are well-documented through case studies and anthropological research, systematic research on their prevalence is still needed This history underscores why a clear typology of misconduct is necessary--to prevent repeated cycles of misconduct and establish ethical safeguards in psychedelic practice

Purpose

This typology identifies and categorizes forms of misconduct by practitioners working with psychedelics in a wide range of contexts. Its primary goal is to provide a clear, foundational framework for understanding ethical violations independent of specific modalities, substances, or cultural traditions While some forms of misconduct may also violate the law, this document focuses on ethical responsibilities rather than serving as a legal code.

By delineating what does and does not constitute appropriate behavior, this typology aims to inform effective policymaking, training, codes of conduct, ethics materials, and research in psychedelic practice

Scope

The typology applies to any setting in which practitioners work with participants under the influence of psychedelics, including but not limited to:

● Clinical research and treatment

● Licensed and medical settings

● Traditional and Indigenous healing practices

● Religious and spiritual ceremonies

● Underground therapy and facilitation

● International Retreats

This document concentrates on practitioner conduct and examines behaviors that:

● Violate universal ethical principles, regardless of cultural or spiritual context

● Can occur with any psychedelic substance or practice

● Often lead to physical, psychological, or spiritual harm

● Exploit the inherent power differential between practitioner and participant

Exclusions

This typology intentionally does not address:

● Legal definitions or jurisdiction-specific regulations

● Standards exclusive to particular modalities or lineages

● Clinical protocols or best practices

● Organizational policies or procedures

● Specific enforcement mechanisms or consequences

● Best practices for psychedelic facilitation

● Guidelines for choosing a psychedelic facilitator

Intrinsic Properties of Psychedelics May Increase Risk for Misconduct

Research has identified several mechanisms through which psychedelic states can create heightened vulnerability to practitioner misconduct Understanding these risk factors is crucial for developing appropriate safeguards and ethical guidelines

1. Emotional Vulnerability: Trauma May Be at the Surface

● Psychedelics can facilitate the recall and reliving of vivid traumatic memories leading to profound emotional exposure (Oram, 2019; Malone et al , 2018; Rose, JR 2024) Even when they do not surface specific traumatic content, they nevertheless heighten emotional excitation and sensitivity, making experiences feel more intense, immersive, and deeply felt (Preller et al., 2017; Preller et al., 2018). It is not uncommon for participants to willingly confront difficult emotions, as psychedelics can foster a sense of

openness and acceptance that makes engaging with unresolved material feel necessary or even meaningful (Roseman et al., 2019).

● Facilitated recall of traumatic memories has been observed not only in case reports but also in clinical trials, which document increased access to traumatic material with MDMA (Mithoefer et al , 2011)

● Neuroimaging research offers insight into why these effects occur Psychedelics disrupt activity within the default mode network, which is believed to maintain our sense of self and high-level beliefs (Carhart-Harris et al., 2014). In loosening these structures, psychedelics may dissolve defense mechanisms, allowing previously avoided or inaccessible material to surface into conscious awareness

● Heightened sensory activation may also contribute to the intensity of recalled experiences Neuroimaging research found that psilocybin enhanced memory vividness and visual imagery while significantly increasing activation in the visual cortex and other sensory processing regions (Carhart-Harris et al., 2012), potentially intensifying recalled experiences.

● Because psychedelics heighten emotional sensitivity and memory vividness, the resurfacing of difficult material can be particularly intense This vulnerability is not inherently harmful it can be deeply healing if supported skillfully However, if mishandled, re-traumatization, suggestive memory distortion, or emotional exploitation could occur.

● Trauma activation may also make participants more dependent on the practitioner for emotional regulation, which can be exploited or mismanaged.

2. Heightened Neuroplasticity: The Stakes Are Higher

● Psychedelics temporarily increase brain plasticity (de Vos, Mason, and Kuypers, 2021), meaning that what happens in and after the session could be more impactful and long-lasting. Therefore, how trauma is processed, framed, or “held” by the practitioner matters more a harmful or dismissive response can leave lasting imprints on self-concept, relationships, or emotional resilience

● Multiple studies confirm that a heightened state of plasticity extends beyond the acute psychedelic experience, with some research indicating that this effect can last for weeks (Calder & Hasler, 2023).

● Animal research demonstrates psychedelics can temporarily reopen critical learning periods following psychedelic experiences, specifically for 2 weeks following a psilocybin or MDMA experience, 3 weeks for LSD, and 4 weeks for Ibogaine (Nardou et al , 2019; Nardou et al , 2023) This reopening reflects not only enhanced plasticity but also metaplasticity - the brain's regulation of plasticity itself

● An extended window of malleability and plasticity in the brain may make the participant sensitive to feedback by the practitioner during not just the journey, but throughout the integration period as well. The extended duration of heightened malleability is well-documented (Calder & Hasler, 2023), though individual variation likely exists

Increased Responsivity to Practitioner Influence and Tendencies to take on Devotee Role

● Research suggests psychedelics enhance suggestibility, making participants more receptive to external ideas, social cues, and authority figures (Oliver et al , 2024) These substances also enhance trust (Dolder et al , 2018; Schmid et al , 2014), which can heighten the influence of the practitioner’s interpretations and guidance

● The dissolution of ego boundaries in the psychedelic state can further blur self-other differentiation (Nour et al., 2016), making it easier for participants to internalize the facilitator’s perspectives as their own. Neuroimaging studies confirm this effect, showing reduced activity in brain regions associated with self-referential processing during psychedelic states (Carhart-Harris et al , 2015; Lebedev et al , 2015), and reduced distinction between neural representations of self and other (Preller et al , 2018) This creates conditions where the participant may be more likely to adopt the practitioner’s interpretations without critically evaluating them.

● The mystical-type experiences frequently induced by psychedelics can elicit powerful emotions like awe, sacredness, and deep gratitude (Ko et al , 2022), which can sometimes be directed toward the facilitator for their role in the experience This may lead to devotional reverence, where the participant perceives the practitioner as possessing unique wisdom or authority (Dupuis 2021) In extreme cases, this dynamic can foster a devotee-like role, reinforcing an asymmetry of power in which the participant relies heavily on the facilitator’s guidance to make sense of their experience (Evans and Adams, 2025).

● The acute state of heightened suggestibility, trust, and reverence has a dual potential: therapeutic benefit in ethical settings, but vulnerability to manipulation, coercion, or undue influence when safeguards are absent Historical analysis reveals instances where this power dynamic has been exploited (Hassan, 2018).

● This heightened suggestibility and reliance on perceived authority figures also have direct implications for epistemic agency the ability to critically interpret and integrate one's own experiences Early research suggests that participants may readily adopt the interpretive frameworks provided by facilitators (Noorani, 2020) When facilitators present their own explanations as definitive truths (e g , “This memory means X,” or “This is proof of an entity attachment”), they risk fundamentally shaping or constraining how participants understand their experiences.

● Note: While these findings are consistent across multiple studies, more controlled research is needed to fully understand this dynamic

4. Compromised Cognition & Decision-Making

● Psychedelics typically impair executive function and cognitive control (Yousefi et al., 2025; Pokorny et al., 2020), potentially making it harder for participants to recognize manipulation or make informed choices.

● Reduced default mode network (DMN) activity and decreased network segregation have been linked to therapeutic benefits, perhaps by relaxing rigid prior beliefs (Carhart-Harris

& Friston, 2019) However, these changes may also temporarily reduce executive function, which could diminish critical reflection in the moment and increase vulnerability to practitioner misconduct.

Misconduct Typology

Terminology

Psychedelic Practitioner facilitates psychedelic experiences for therapeutic, spiritual, or personal growth purposes A psychedelic practitioner could be a ceremonial leader, a spiritual leader, an indigenous or traditional healer, a western trained clinician or any other kind of facilitator who works with people in psychedelic states. These practitioners may or may not be trained or licensed to lead psychedelic experiences, and their backgrounds can vary, including those with or without formal training in mental healthcare or medicine. They may facilitate individual sessions, group sessions, or both. They may or may not be paid for these services. The practitioner is responsible for the participants' wellbeing and physical safety for the duration of the psychedelic experiences. They may or may not provide guidance or therapy in the integration period following a psychedelic experience

Participants work with a psychedelic practitioner and remain in their care during the acute psychedelic experience, and possibly for an extended period afterward The participant may be working with the practitioner alone or in a group The participant may pay for the psychedelic experience or there may not be a financial exchange. Participants vary in their knowledge of psychedelics and engage with them for different reasons some seeking relief from long-standing PTSD or depression, while others explore them for general well-being.

Key Assumptions

Psychedelic practitioners bear extraordinary ethical and professional responsibility due to unique factors that distinguish these relationships from other therapeutic contexts:

1 Participants enter highly vulnerable and suggestible states that amplify the inherent power differential between practitioner and participant

2 The neuroplasticity and psychological openness induced by psychedelics may create extended periods of heightened vulnerability

3. The potential for spiritual and psychological influence exceeds that found in typical therapeutic relationships

These factors create a level of participant vulnerability that exceeds most professional relationships, including traditional medical or therapeutic contexts This dynamic necessitates a heightened commitment to ethical behavior, clear boundaries, and ongoing self-awareness

Categories of Misconduct By Psychedelic Practitioners

This document identifies two categories of misconduct:

● Category 1 Misconduct identifies practices that almost all professional, cultural, and legal systems would recognize as major ethical breaches

● Category 2 Misconduct covers a broader, subtler range of unethical behaviors that may be overlooked or downplayed if practitioners and participants lack a clear ethical framework

Category 1 Misconduct: Egregious Misconduct

Definition: Category 1 Misconduct includes behaviors that are unequivocally unethical and often illegal, posing immediate and significant harm to participants. These acts involve blatant abuses of power, severe breaches of consent or trust, and frequently contravene legal regulations in many jurisdictions. Because psychedelics can amplify vulnerability and power imbalances, Category 1 violations are particularly harmful and warrant immediate intervention Misconducts in Category 1:

● Typically meets or exceeds thresholds for criminal liability or professional disciplinary action.

● Represents severe abuse of the inherent power differential in psychedelic contexts

● Causes immediate or high-risk harm (physical, psychological, or spiritual) to participants

Category 2 Misconduct: Significant Ethical Violations

Definition: Category 2 Misconduct involves behaviors that may not always be explicitly illegal but raise significant ethical concerns and can cause harm over time These can be more difficult to recognize or prove because they often unfold subtly during the heightened suggestibility and vulnerability of psychedelic states. Despite sometimes being less overt, these actions still undermine participant well-being, autonomy, and the integrity of the practitioner-participant relationship Misconducts in Category 2 Misconduct:

● May not meet legal thresholds for criminality but remains ethically problematic and harmful

● Exploit the amplified suggestibility and openness of participants in more insidious or less immediately obvious ways.

● Causes significant erosion of trust and safety, which can accumulate into deeper harm over time

Category 1 Misconduct

Sexual Misconduct:

Overview:

In the context of psychedelic work, the combination of altered states, intimate therapeutic or ceremonial settings, and inherent power differentials renders sexual relationships between practitioners and participants categorically unethical even where “consent” appears to be given. The heightened suggestibility and vulnerability that often accompany psychedelic experiences create conditions in which genuine informed consent for sexual or romantic activity is nearly impossible Moreover, the potential for exploitation can persist well after the acute session ends, extending into the sensitive integration period and sometimes beyond.

Forms of Sexual Misconduct:

● Sexual Contact or Intimacy: Any physical or sexual activity initiated by a practitioner during or after psychedelic sessions (the length of time after a session varies according to various codes of conduct and context).

● Sexual Touch: Any physical contact of a sexual nature or with sexual implications, made by a practitioner toward a participant, and especially touch of participant erogenous zones This includes both overt and subtle forms of touch, which are especially harmful given participants' vulnerability in altered states where capacity for consent is fundamentally compromised

● Coercive Undressing/Exposure: Pressuring participants to remove clothing for non-therapeutic reasons, or exposing oneself without the participant’s explicit prior consent

● Sexual Harassment or Grooming Behaviors: Inappropriate advances, suggestive comments, or incremental boundary-pushing intended to desensitize participants over time

● Sexual Comments or Advances: Any verbal or non-verbal sexual overture, even if framed as part of “spiritual healing.”

● Attempting to Initiate Romantic Relationships: Seeking a romantic or sexual connection during or after the professional relationship, exploiting the long-lasting power differential and emotional intimacy formed in psychedelic work

Why It’s Misconduct:

● Risk of Psychological and Spiritual Harm: Sexual misconduct can lead to confusion, re-traumatization, and lasting psychological harm, undermining therapeutic or spiritual benefits.

● Compromised Consent: Due to the inherent power differential and the altered state of consciousness, true informed consent cannot be meaningfully given in these contexts.

● Exploitation of Trust and Authority: Practitioners occupy positions of power, whether through formal credentials, spiritual leadership, or specialized knowledge Any sexual or romantic engagement exploits this imbalance, often leaving participants vulnerable to manipulation and harm

Financial Exploitation:

Overview

Financial exploitation occurs when a psychedelic practitioner abuses their position of power and trust to extract or manipulate money or other valuables from a participant. Because psychedelics frequently induce heightened suggestibility and emotional vulnerability, participants are at particular risk of financial manipulation both during and after sessions Clear, transparent, and agreed-upon financial arrangements are therefore an ethical cornerstone of all psychedelic practices

Forms of Financial Exploitation:

● Requesting Additional Payments During Sessions: Practitioners asking for or demanding money or valuables while participants are under the influence of psychedelics

● Altering Terms After the Fact: Any post-session shift in fee or payment structure without the participant’s clear, prior agreement

● Promising Guaranteed Outcomes: Offering “guaranteed” therapeutic or spiritual results that are contingent on extra payments or donations.

● Pressuring for More Funds or Assets: Using fear, guilt, shame, or claims of spiritual necessity to coerce participants into paying beyond what was initially agreed upon

● Excessive or Hidden Fees: Charging rates that far exceed agreed-upon services or adding undisclosed “service charges” or “spiritual tithes ”

● Unfair Refund Policies: Making refunds difficult or impossible for participants who withdraw before or during the process for ethical or safety reasons.

Why It’s Misconduct:

● Abuse of Power and Trust: Financial transactions in a therapeutic or ceremonial setting must be based on clear agreements, not manipulation Exploiting a participant’s trust for financial gain breaches professional and ethical integrity.

● Violation of Informed Consent: Ethical financial agreements should be established when participants are in a clear-headed state, not during or immediately after a psychedelic experience Any deviation from prior agreements undermines informed decision-making

● Exploitation of Emotional and Psychological Vulnerability: Participants often seek psychedelic experiences for healing or personal growth, placing significant trust in the practitioner. Financial manipulation takes advantage of this trust and can lead to emotional distress, disillusionment, and financial harm

● Deception and Coercion: Pressuring participants for additional payments, altering financial terms post-session, or making promises of guaranteed outcomes in exchange for money constitutes financial misconduct and potential fraud

Fraud

Overview

Fraud occurs when a psychedelic practitioner deliberately deceives participants whether for personal, financial, or reputational gain. Psychedelic experiences involve heightened states of vulnerability and suggestibility, making transparency and truthfulness paramount for participant safety and for upholding ethical standards. By withholding accurate information or providing false information, practitioners both violate participant trust and potentially expose participants to harm

Forms of Fraud in Psychedelic Practice

● Misrepresentation of Substances: Providing substances different from those agreed upon, using compounds of unknown or compromised purity, or misrepresenting dosages and providing a higher or lower dose than was consented to. Providing proprietary blends without full ingredient disclosure, preventing participants from assessing potential contraindications for themselves and making truly informed decisions

● Misrepresentation of Qualification: Falsely claiming professional credentials, experience, or expertise This includes inventing or exaggerating training, and claims of indigenous or traditional lineage where none exist

● Misrepresentation of Benefits: Guaranteeing specific outcomes, claiming cures for medical/psychological conditions, or overstating spiritual or psychological benefits Also includes deliberate withholding or downplaying of known risks and contraindications, or fabricating success stories/testimonials.

Why It’s Misconduct:

● Violation of Informed Consent: Ethical psychedelic practice requires full transparency about substances, risks, qualifications, contraindications, and expected outcomes

Deception undermines a participant’s ability to make informed choices, which can lead to unsafe or unwanted experiences

● Risk of Physical and Psychological Harm: Providing unknown or misrepresented substances, incorrect dosages, or exaggerated claims can result in adverse reactions, medical emergencies, or deep emotional distress Participants may delay necessary medical care if led to believe psychedelics will “cure” conditions that require other treatments

● Erosion of Community Trust: Fraud damages the reputation of responsible practitioners and communities, undermining public and community trust in psychedelic work.

● Breach of Trust: Participants rely on practitioners to be truthful, especially in vulnerable states Misrepresentation of substances, credentials, or benefits takes advantage of this trust, potentially leading to harm

● Exploitation for Personal Gain: Fraudulent claims, especially those that involve financial incentives or reputation-building, prioritize the practitioner’s self-interest over participant safety and well-being.

Physical Abuse:

Overview

Physical safety lies at the core of ethical psychedelic practice Any act that intentionally causes physical harm or uses force without proper consent such as striking, restraining, or otherwise physically overpowering a participant violates the participant’s autonomy and well-being While some ceremonial or therapeutic contexts may involve physically intense processes (e g , purging rituals, bodywork), participants must always provide free, prior, and informed consent while in a clear and unaltered state During a psychedelic experience, the individual’s heightened vulnerability and altered perception amplify the potential harm from any uninvited or non-consensual physical intervention.

Forms of Physical Abuse

● Hitting, Slapping, or Striking: Any form of intentional violence or aggression.

● Restraint without Prior Consent: Using physical or mechanical restraints without clear, documented consent or outside of a genuine emergency where the participant poses an immediate threat to themselves or others

● Forced Body Positioning without Prior Consent: Compelling participants to maintain postures or movements without prior consent that cause pain or distress, unless explicitly consented to in a non-altered state.

● Coercive “Bodywork”: Applying physical pressure or manipulations under the guise of therapy without the participant’s informed permission and a qualified practitioner’s oversight

● Lack of Safety Protocols: Failing to provide adequate support, supervision, or environment to keep participants physically safe during ceremonies (e g , ignoring hazards, lack of spotters during purge or movement exercises).

● Forced Confinement / Unlawful Restraint: Any situation in which participants are physically or psychologically barred from leaving the premises, have their travel documents or possessions confiscated, or are otherwise detained against their will

Why it’s Misconduct:

● Risk of Immediate Harm: Physical force can cause direct injury, pain, or lasting trauma. Under the influence of psychedelics, participants may be unable to protect themselves or accurately assess the danger they face

● Potential for Re-traumatization: Many individuals seek psychedelic experiences to heal from past trauma Non-consensual physical contact can trigger or worsen traumatic memories, undermining the therapeutic intent of the session

● Violation of Informed Consent: Consent obtained while someone is under the influence of psychedelics is ethically invalid. Participants must be fully informed and unimpaired when agreeing to any physically intense practice or intervention

● Abuse of Power and Control: Using physical force, coercion, or restraint outside of emergency safety concerns violates participant autonomy and exploits the inherent power imbalance in the practitioner-participant relationship

● Violation of Professional & Community Standards: Across most professional and indigenous/traditional codes of conduct, any form of physical aggression or non-consensual contact is condemned Such acts erode trust not only between individual participants and facilitators but also in the broader psychedelic community.

Violation of Consent and Coercion:

Overview

Respect for participants’ autonomy stands at the heart of ethical psychedelic practice Because altered states can heighten vulnerability and reduce critical thinking, obtaining voluntary, informed, and unpressured consent is paramount Any infringement on a participant’s ability to freely choose be it through force, deceit, or subtle manipulation constitutes a violation of consent or coercion. Practitioners must exercise heightened diligence, given the inherent power differential and the risk of undue influence in psychedelic contexts

Forms of Violation of Consent:

● Administering Substances Without Explicit Consent: Giving participants any psychedelic compound without their prior, clear agreement.

● Changing Agreed-Upon Protocols Mid-Session: Altering dosage, schedule, or other key aspects after the session begins, without obtaining explicit re-consent

● Ignoring Withdrawal of Consent: Continuing a procedure or protocol even after a participant indicates they no longer wish to proceed

● Non-Consensual Touch: Any form of physical contact therapeutic, spiritual, or otherwise initiated without explicit, informed consent.

● Violations of Agreed-Upon Boundaries During Altered States: Failing to honor previously established limits once the participant is under the influence and potentially more vulnerable.

● Non-Consensual use of Unauthorized Therapeutic Techniques: Implementing therapeutic methods or psychological interventions during acute experience without fully informing participants or obtaining their consent ahead of time

● Decision-Making on Behalf of Participants: Making substantial choices for participants during altered states rather than confirming or respecting their wishes.

● Unauthorized Recording/Sharing of Information: Filming, photographing, or posting details about participants without their express permission, including requesting testimonials in the days immediately following an experience when their capacity for fully informed consent may be compromised

● Experimenting With Unverified Substances: Administering or testing compounds of unknown purity or effect without comprehensive informed consent and proper safety measures

● Unapproved Research Conduct: Conducting any type of study or data collection without participant consent or required Institutional Review Board (IRB) approval

Forms of Coercion:

Coercion occurs when a practitioner pressures, manipulates, or forces participants to engage in behaviors they have not freely chosen This can be explicit (e g , threats or force)

● Coercion of Participation: Forcing or pressuring a participant to engage in an activity or take a psychedelic substance they did not freely consent to

● Coercion of Dosage: Urging or pushing a participant to take higher doses than they initially agreed upon

● Coercion of Continued Use: Pressuring participants to partake in repeated ceremonies or sessions without their clear, voluntary agreement.

Why It’s Misconduct:

● Violation of Autonomy and Human Dignity: Every individual has the fundamental right to make informed choices about their own body, mind, and experiences Any act that overrides participant agency whether through force, deceit, or subtle manipulation is a direct violation of ethical and human rights principles.

● Breach of Trust and Professional Responsibility: Practitioners are in positions of authority and responsibility. Any form of coercion, non-consensual intervention, or boundary violation betrays the trust participants place in them and compromises the integrity of psychedelic practice

● Risk of Psychological and Spiritual Harm: Being forced, deceived, or manipulated into actions one did not fully consent to can lead to distress, confusion, re-traumatization, or lasting psychological harm These experiences may undermine the potential therapeutic or spiritual benefits of psychedelic work.

● Legal and Ethical Standards: Across medical, psychological, spiritual, and indigenous traditions, coercion is unequivocally condemned. Violating consent can lead to serious legal ramifications and erode trust in both individual practitioners and the broader psychedelic field

Abandonment:

Overview

Abandonment occurs when a psychedelic practitioner leaves the participant alone and unsupervised for an extended period or permanently during any phase of the psychedelic experience. Psychedelic sessions can evoke intense emotional, psychological, or physical reactions, and the participant’s altered state significantly heightens their vulnerability Practitioners bear an ethical responsibility to remain available for support, ensure safety, and respond promptly to emergencies.

Forms of Abandonment:

● Leaving Mid-Session: Exiting the space for an extended period (or permanently) while the participant is actively under the influence of psychedelics

● Inadequate Staffing or Support: Failing to ensure that trained assistants or co-facilitators are present if the primary practitioner must step away briefly

● Neglecting Emergent Needs: Ignoring calls for help or failing to provide supportive measures when participants exhibit signs of distress or confusion.

● Premature Termination: Ending the session before the participant has returned to a relatively stable, baseline state, without ensuring an appropriate handoff or aftercare plan.

Why It’s Misconduct:

● Neglect of Safety Responsibilities: Participants may experience physical disorientation, overwhelming emotions, or unpredictable reactions Leaving them unattended increases the risk of self-harm, medical emergencies, or psychological distress

● Breach of Duty of Care: Ethical guidelines across medical, psychological, and indigenous traditions emphasize the practitioner’s responsibility to provide continuous care and oversight Psychedelic participants are especially vulnerable, and without a practitioner’s presence, they have no immediate resource for help or grounding

● Disruption of Therapeutic or Spiritual Processes: Psychedelic experiences often require careful facilitation Participants often need reassurance, guidance, and sometimes intervention (e.g., in cases of severe anxiety or adverse reactions). Without continuity of support, participants may struggle with distressing experiences, missed opportunities for integration, or worsened psychological outcomes

● Breach of Trust: Leaving someone alone in a highly vulnerable state undermines the integrity of the practitioner-participant relationship and can cause long-term harm or betrayal of trust

Category 2 Misconduct

Verbal, Psychological, and Emotional Misconduct

Overview:

Verbal, psychological, and emotional misconduct can be less visible than physical harm but deeply damaging, especially in the heightened vulnerability of psychedelic experiences It can be overt, such as yelling, intimidation, or ridicule, or more subtle, like gaslighting, emotional manipulation, or pressuring participants to adopt specific interpretations of their experience. Practitioners who position themselves as spiritual authorities or healers can misuse their influence to override participant autonomy or manipulate vulnerable individuals through coercive spiritual narratives

Forms of Verbal, Psychological, and Emotional Misconduct:

● Fear and Intimidation: Using threats, raised voices, aggressive language, or creating an atmosphere of fear to control participants

● Belittling or Humiliating Remarks: Ridiculing participant experiences, dismissing or mocking emotional responses, or shaming participants for their reactions.

● Derogatory Language or Slurs: Employing offensive or discriminatory language related to race, ethnicity, gender, sexuality, religion, or other protected categories.

● Undermining Personal Meaning-Making: Imposing rigid interpretations of psychedelic experiences that undermine a participant's personal meaning-making process This includes steering participants toward a specific explanatory framework such as childhood trauma, past-life experiences, or entity encounters in a way that overrides their own agency in making sense of their experience This includes conduct in which distressing memories arise and are either assumed to be absolutely accurate or, alternatively, dismissed outright While the nature of recovered memories remains a complex and debated topic, it is important to create space for participants to explore their experiences without coercion or premature conclusions.

● Coercive Spiritual and Religious Framing: Using spiritual beliefs or frameworks to override participant consent, control a participant’s experience, or impose unsolicited interpretations

Why It’s Misconduct:

● Risk of Psychological and Emotional Harm: Verbal abuse, coercion, and emotional manipulation can cause lasting distress, especially when experienced in vulnerable states. Participants may internalize shame, fear, or self-doubt, leading to emotional injury that persists beyond the session

● Erodes self-esteem and autonomy: Undermines a participant’s ability to trust their own perceptions, especially in a vulnerable mental state.

● Abuse of Power and Influence: Facilitators hold a position of authority, whether through therapeutic expertise or spiritual leadership. Using this power to belittle, intimidate, or manipulate participants is an abuse of trust and responsibility

● Disrupts potential for healing: Undermines the healing process by disrupting the safety needed for safe and effective psychedelic facilitation rather than holding space with care, a facilitator who imposes authority or diminishes a participant’s experience through shame or ridicule hinders integration and trust

● Breach of Ethical and Professional Standards: Across therapeutic, spiritual, and indigenous traditions, verbal and psychological abuse contradicts the fundamental duty of care. Such actions erode confidence in responsible psychedelic practice and damage the credibility of practitioners and the broader psychedelic field.

Induced Control and Exploitation

Overview:

Not all forms of manipulation involve overt force or immediate consent violations Some facilitators employ long-term psychological, spiritual, or ideological control tactics that sustain power imbalances, induce dependency, or suppress participants’ ability to critically evaluate their experiences. These behaviors are often self-serving, designed to advance the facilitator’s financial, reputational, or ideological interests rather than prioritizing the participant’s well-being This can include pressuring participants into unnecessary sessions, coercing endorsements, or using spiritual authority to evade accountability. Unlike direct violations of consent (Category 1), these forms of manipulation unfold over time, often blurring the line between guidance and control in ways that can be difficult for participants to recognize until after harm has occurred Ethical facilitation requires transparency, respect for participant agency, and a commitment to their well-being rather than self-serving manipulation

Forms of Coercion, Control, and Exploitation Misconduct:

● Psychological Exploitation: Inducing dependence, invalidating perceptions, distorting reality for personal gain, creating crises to maintain control, manipulating trauma bonds, and exploiting vulnerability through transference. Cultivating a narrative that participants require ongoing facilitation, additional sessions, or continuous mentorship to maintain healing, even when unnecessary.

● Spiritual and Religious Manipulation: Using claims of divine guidance to justify unethical behavior, evade accountability, exploiting participants' spiritual experiences for control, or manipulating sacred or religious concepts for personal gain.

● Ideological Coercion: Promoting personal political or ideological agendas, requiring adherence to specific belief systems, using psychedelic experiences to indoctrinate, manipulating participants into supporting causes, exploiting altered states for propaganda, or enforcing rigid thought patterns or beliefs

● Suppression of Dissent: Retaliating against those who question methods, ostracizing ethical concerns, threatening to withhold support, and using tactics like gaslighting, group pressure, and isolation to silence criticism and discourage ethical scrutiny

● Dismissing Harm as 'Necessary Growth': Convincing participants that any distressing or harmful experience they had was a necessary part of the journey rather than a result of practitioner misconduct

● Pressuring Participants for Endorsements: Encouraging or coercing participants to provide positive reviews, social media posts, or endorsements about the facilitator, even if their experience was neutral or negative

● Financial or Professional Exploitation: Taking advantage of a participant’s limited understanding of psychedelic mechanisms to persuade them that they require unnecessary additional sessions or ongoing support, fostering dependency for financial or professional gain.

Why It’s Misconduct:

● Violation of Personal Agency: Coercive tactics such as pressuring participants into additional sessions, endorsements, or adherence to specific beliefs override a

participant’s ability to make independent choices about their own healing process Ethical facilitation prioritizes participant agency rather than fostering dependence.

● Exploitation of Trust for Personal Gain: Facilitators hold a position of influence and responsibility. Using that power to induce psychological, financial, or ideological dependence serves the facilitator’s interests rather than the participant’s well-being, making it an abuse of trust

● Breach of Ethical Transparency and Accountability: Suppressing dissent, ostracizing critics, or using spiritual or ideological justification to evade responsibility creates an environment where misconduct goes unchecked Ethical practice requires openness to scrutiny and participant concerns.

● Potential for Long-Term Psychological Harm: Participants who are subjected to coercive control may internalize harmful narratives, feel trapped in cycles of dependence, or struggle to recognize misconduct until significant harm has occurred. This can lead to prolonged emotional and psychological distress

● Undermining Voluntary and Informed Consent: Misleading, pressuring, or manipulating participants into further financial, spiritual, or ideological commitments distorts the foundation of informed consent Ethical practice requires that participants engage voluntarily, without undue influence.

Unsafe Physical Environment

Overview

Psychedelic experiences can be profoundly sensitive, making the choice of setting crucial to participant well-being An environment that is physically unsafe (e g , fire hazards, lack of ventilation, inadequate sanitation) or emotionally destabilizing (e g , crowded public areas, unsupervised communal spaces) can significantly heighten risks

Forms of Unsafe Physical Environment:

● Unsupervised or Public Settings: Holding ceremonies or sessions in places where bystanders can interfere, or where participants cannot be monitored (e g , parks, festivals without secure private space).

● Overly Crowded Ceremonies: Large groups in limited space can increase the risk of accidents, reduce practitioner oversight, and compromise participants’ sense of safety.

● Ignoring Environmental Protocols: Failing to address or disclose weather-related risks (e g , heat, cold, flooding) in outdoor ceremonies

● Lack of Basic Sanitation: Insufficient restroom facilities, clean water, or hygienic conditions that can lead to physical harm or distress

Why It’s Misconduct

● Negligence in Ensuring Physical Safety: Facilitators have a fundamental responsibility to provide an environment free from foreseeable dangers Failure to mitigate risks such as fire hazards, extreme temperatures, or inadequate sanitation constitutes negligence

and exposes participants to preventable harm This is especially problematic when participants in non-ordinary states are less aware of their surroundings or unable to respond effectively to hazards themselves (e.g., fire, trip-and-fall risks).

● Breach of Duty of Care: Most professional and cultural codes require facilitators to prioritize participant safety Failing to establish clear protocols for emergencies, supervision, or environmental risks violates this basic ethical obligation

● Compromised Psychological and Emotional Safety: Psychedelic experiences can be profoundly sensitive, and an unsafe or chaotic setting may cause distress, anxiety, or disorientation. Participants rely on facilitators to create a stable environment conducive to healing and self-exploration

● Failure to Provide Proper Supervision: Holding sessions in public or unsupervised settings, or overcrowding ceremonies beyond the facilitator’s capacity to provide oversight, endangers participant well-being and erodes trust in the integrity of the practice.

Breach of Confidentiality:

Participants share sensitive information about their physical, mental, spiritual, or cultural contexts as part of their intake and during their sessions Breaching confidentiality includes sharing these details verbally or digitally without explicit participant consent

Forms of Breach of Confidentiality:

● Unauthorized Disclosure: Telling others about a participant’s experiences, personal data, or mental health conditions.

● Improper Use of Recordings: Filming or recording sessions without informed consent (also category 1, violation of consent); posting clips or quotes online

Why It’s Misconduct:

● Violation of Trust and Ethical Duty: Confidentiality is a foundational principle in therapeutic, medical, and spiritual practices Breaching it undermines participant trust, which is essential for creating a safe and supportive environment.

● Compromises Participant Safety and Well-Being: Sharing sensitive information without consent can expose participants to stigma, discrimination, or unintended personal, professional, or legal consequences especially in regions where psychedelic use carries legal or social risks

● Undermines the Integrity of the Facilitator-Participant Relationship: Participants may feel betrayed, exploited, or hesitant to fully engage in the process if they fear their private experiences could be shared without their permission This can diminish the depth of their engagement and overall healing potential.

● Breach of Professional and Legal Standards: Many professional and indigenous codes emphasize confidentiality as a core ethical requirement Unauthorized disclosure violates both ethical norms and, in some cases, privacy laws or cultural agreements.

Negligence:

Negligence occurs when practitioners fail to fulfill their fundamental duty of care through acts of omission or substandard practices. Unlike intentional misconduct, negligence often manifests through inadequate preparation, impaired judgment, or failure to follow essential safety protocols The heightened vulnerability of participants in psychedelic states makes practitioner negligence particularly dangerous.

Forms of Negligence:

● Practitioner Impairment

○ Facilitating sessions while under the influence of alcohol or other substances that compromise judgment.

○ Operating in a physically or emotionally compromised state (severe illness, mental distress, extreme exhaustion)

○ Failing to maintain the clarity and presence needed for participant safety

○ Note: In many traditional and underground contexts, ceremonial co-consumption occurs within established safety protocols

● Medical and Psychological Screening Failures

○ Omitting thorough intake processes to identify health conditions.

○ Failing to screen for mental health contraindications

○ Neglecting to verify current medications and potential interactions

○ Inadequate assessment of participant readiness and risk factors

● Substance Safety Violations

○ Combining substances without proper medical knowledge (e.g., MAOIs with SSRIs).

○ Improper storage or handling leading to contamination or degradation, or otherwise compromising substance integrity

○ Inadequate labeling creating dosage confusion

● Emergency Response Deficiencies

○ Failure to engage emergency services when necessary during crises.

○ Delay or hesitation in calling for medical help due to legal concerns or reputational fears

○ Insufficient access to emergency services or reliable communication methods

● Risk Management Failures

○ Failure to provide informed consent

○ Omitting essential mental health or medical history checks, missing risk factors that could result in adverse reactions

○ Failing to inform participants about potential side effects or therapeutic challenges.

● Overloading Schedules

○ Running back-to-back ceremonies without allowing sufficient time for rest, integration, or physical recovery

Why It's Misconduct:

● Breach of Duty of Care: Practitioners have an ethical responsibility to ensure participant safety, preparation, and appropriate response to risks Failing to meet basic standards of care whether through lack of preparation, poor screening, or impaired judgment constitutes negligence and endangers participants

● Violation of Informed Consent: Failing to properly screen participants, disclose risks, or provide adequate safety measures undermines their ability to make informed decisions about their participation. Participants cannot truly consent to an experience if they are not given critical safety information

● Increased Risk of Preventable Harm: Negligence, unlike intentional harm, often results from oversight, but its consequences can be just as severe Failing to screen for contraindications, respond to emergencies, or maintain substance safety protocols can lead to medical crises, psychological distress, or long-term harm.

● Erosion of Trust and Professional Integrity: Participants enter these experiences with the expectation that facilitators will act with competence, diligence, and responsibility When practitioners fail to uphold basic safety standards, they betray this trust and compromise the legitimacy of the field

Discrimination:

Overview

Discrimination occurs when practitioners provide different treatment, deny access to care, or create hostile environments based on participants' personal characteristics such as race, ethnicity, gender, sexual orientation, socio-economic status, disability, age, or religion. In psychedelic contexts, discrimination is particularly harmful as it can compound existing trauma and compromise the safety of vulnerable participants during altered states.

Forms of Misconduct:

● Unequal Treatment Based on Identity (Race, Gender, Sexuality, Disability, Socioeconomic Status): Favoring, excluding, or mistreating participants based on race, gender, sexual orientation, disability, socioeconomic status, or other personal characteristics.

● Creating Hostile or Unsafe Environments for Marginalized Participants: Allowing unchecked bias, microaggressions, or overt discrimination to persist in psychedelic spaces without intervention

● Derogatory Language & Slurs: Using offensive or discriminatory language related to participants’ identity, including racist, sexist, ableist, or homophobic remarks.

● Gatekeeping & Restricted Access: Withholding participation, mentorship, or community support based on personal biases rather than ethical or safety concerns.

Why It's Misconduct:

● Violation of Fundamental Human Dignity and Rights: Every participant has the right to be treated with respect, fairness, and equity. Discrimination contradicts the core ethical principles of non-maleficence (do no harm) and justice in care

● Breach of Professional and Ethical Standards: Facilitators are responsible for ensuring an inclusive, non-discriminatory environment Favoring, excluding, or mistreating participants based on identity violates the ethical duty to provide equitable access and support.

● Compounding Historical and Systemic Trauma: Many individuals from marginalized backgrounds seek psychedelic experiences for healing past trauma Discriminatory treatment can reinforce oppression, deepen wounds, and exacerbate distress

● Undermining Trust and Psychological Safety: Participants enter these experiences expecting care and support When practitioners engage in discrimination whether overtly or through microaggressions they compromise the therapeutic alliance and create an environment where participants feel unsafe or unwelcome, with the potential to exacerbate psychological distress

● Obstructing Access to Healing: Psychedelics have the potential to be transformative, but discrimination creates barriers to participation, preventing individuals from accessing healing opportunities that should be available to all

Appropriation:

Overview:

Appropriation occurs when practitioners adopt, commodify, or facilitate access to spiritual or cultural practices, especially from Indigenous or other historically marginalized communities, without proper understanding, respect, or permission often for personal or financial gain.

Forms of Appropriation:

● Misappropriation of Rituals or Symbols: Using sacred objects or ceremonies without proper guidance, context, or lineage

● False Claims of Lineage or Training: Stating affiliation with a particular tribe or tradition for marketing or prestige.

● Commodified Sacred Traditions: Charging high fees for “authentic” rituals while disregarding the broader cultural or historical significance.

● Exploitative Engagement with Indigenous Communities: Bringing participants to indigenous-led ceremonies without ensuring fair compensation, consent and respect for traditional ways.

Why It’s Misconduct:

● Deception and Misrepresentation: False claims of lineage, training, or cultural authority mislead participants, eroding trust and diminishing the integrity of psychedelic

practice Ethical facilitation requires honesty and transparency about one’s background and qualifications.

● Exploitation and Commodification of Sacred Traditions: Using Indigenous or marginalized communities’ spiritual practices for personal or financial gain without proper permission, respect, or reciprocity turns sacred traditions into marketable products, stripping them of their depth and meaning

● Perpetuation of Colonial and Extractive Practices: Profiting from Indigenous traditions without fair compensation or meaningful consent continues historical patterns of cultural exploitation. Ethical engagement requires collaboration, mutual respect, and recognition of Indigenous intellectual and spiritual sovereignty

● Harm to Indigenous Communities and Practitioners: Facilitating access to Indigenous-led ceremonies without ensuring fair compensation, respecting traditional protocols, or considering the well-being of the community prioritizes outsider interests over those of Indigenous healers and their traditions.

Blurred Boundaries & Dual Relationships

Dual relationships occur when practitioners add another, overlapping role (e.g., friend, lover, business partner, donor, etc ) with a participant beyond the therapeutic or ceremonial context While not always unethical, they can blur boundaries, compromise objectivity, invite conflicts of interest, and create role confusion, thereby distorting the practitioner-participant dynamic. Similarly, inappropriate self-disclosure in which a practitioner overshares personal dilemmas or past traumas can shift emotional burden onto participants, disrupting the intended focus of the experience. Clear boundaries are essential to maintaining a safe and ethical space where participants can engage in their experiences without external pressures or unspoken expectations.

Forms of Blurred Boundaries and Role Violations :

● Personal/Familial Ties: Providing services to close friends or relatives in a way that compromises objectivity, professional judgment, or the integrity of the facilitator-participant relationship

● Donor-Recipient and Professional Relationship Conflicts: Facilitating psychedelic experiences for donors, financial supporters, or professional contacts including employees in ways that mix professional and therapeutic dynamics

● Romantic or Sexual Entanglements: Addressed as Category 1 if overtly exploitative, but even subtler romantic overtures can become a Category 2 violation

● Inappropriate Self-Disclosure: Practitioners oversharing personal dilemmas or trauma, transferring emotional burden onto participants.

Why It’s Misconduct:

● Compromises the Integrity of the Facilitator-Participant Relationship: The practitioner’s role is to hold a stable, supportive container for the participant’s

experience Blurring boundaries whether through personal entanglements, dual roles, or inappropriate self-disclosure disrupts this dynamic and shifts the focus away from participant well-being

● Creates Conflicts of Interest and Power Imbalances: When facilitators have overlapping personal, financial, or professional relationships with participants, their objectivity and decision-making can become compromised Participants may feel pressure to meet unspoken expectations, making it difficult to maintain a truly consensual and therapeutic dynamic

● Fosters Emotional Dependency and Role Confusion: Dual relationships can distort the practitioner’s authority, leading participants to feel obligated to engage beyond their comfort level whether in continued sessions, financial exchanges, or emotional caretaking This undermines participant autonomy and self-trust

● Inappropriate Self-Disclosure Shifts Emotional Burden: When practitioners overshare personal dilemmas or traumas, participants may feel responsible for offering emotional support rather than focusing on their own process. This reversal of roles compromises the safety and neutrality of the experience

● Undermines Ethical and Professional Standards: Clear boundaries are a fundamental ethical principle in therapeutic, ceremonial, and spiritual spaces. Blurred boundaries can lead to exploitation, favoritism, or harm, even in subtle ways, eroding trust in the practitioner and the broader psychedelic field

Harmful Group and Social Dynamics

Group session misconduct occurs when practitioners fail to establish, maintain, or enforce appropriate boundaries and safety protocols in group psychedelic experiences. The collective nature of group work can amplify both healing potential and risk of harm, requiring practitioners to skillfully manage group dynamics while protecting individual participants' wellbeing and confidentiality

Forms of Group Session Misconduct

● Boundary Violations: Failure to establish and enforce clear guidelines around personal information sharing, participant interactions, and professional structure in group settings This includes allowing inappropriate disclosures between participants and failing to maintain the protective container necessary for group safety

● Harmful Group Dynamics: Enabling or ignoring toxic patterns within groups, such as scapegoating, exclusionary cliques, power struggles, or unhealthy competition between participants These dynamics are particularly damaging during psychedelic experiences when participants are in vulnerable states

● Screening and Composition Failures: Inadequate assessment of group compatibility and failure to consider crucial factors like experience levels, interpersonal dynamics, and cultural considerations when forming groups. Poor screening can compromise both individual and collective safety during sessions.

● Conflict Management Deficiencies: Failure to address conflicts and safety concerns promptly within the group setting. This includes lacking clear conflict resolution protocols, ignoring emerging tensions, and inadequately mediating disputes between participants, which can destabilize the therapeutic container

● Favoritism and Inner Circles: Creating inner circles or special status groups, fostering unhealthy competition, or establishing rigid hierarchies within group sessions can lead to power imbalances between group members Favoritism whether through granting special privileges, selectively withholding access, or using artificial. scarcity undermines group cohesion and participant well-being, reinforcing a dynamic where control is maintained through exclusivity rather than mutual trust and respect Such practices undermine group cohesion and participant wellbeing

Why It's Misconduct:

● Failure to Ensure a Safe and Ethical Group Environment: Facilitators are responsible for establishing and maintaining a secure space where all participants feel respected, supported, and protected Neglecting this duty exposes participants to harm, group dysfunction, and breaches of confidentiality

● Exploitation of Power and Influence: Favoritism, inner circles, or rigid hierarchies within a group setting create unhealthy dynamics that can foster exclusion, coercion, and dependency. Ethical group facilitation requires impartiality and a commitment to participant well-being over social or personal gain.

● Compounding Vulnerability Through Group Pressure: Psychedelic states heighten suggestibility and emotional openness, making group pressure particularly potent If facilitators allow unchecked social coercion, participants may feel forced to conform, disclose personal experiences, or engage in actions that do not align with their personal boundaries.

● Neglect of Conflict Resolution and Safety Protocols: Group settings require careful mediation to prevent harm. Failing to address conflicts, unsafe dynamics, or participant incompatibility can result in emotional distress, retraumatization, or breakdowns in the therapeutic or ceremonial process

● Breach of Ethical Responsibility to Screen and Structure Groups: Group composition and structure significantly impact safety and outcomes. Failing to assess participant readiness, interpersonal dynamics, or cultural considerations can lead to mismatched groups where harm is more likely to occur.

● Erosion of Trust in Group Healing Processes: When facilitators allow harmful group dynamics, participants may lose faith in the safety and integrity of the group process This can have lasting consequences on their willingness to engage in future healing or community-based work.

References

Background and History References

● The Role of Spiritual Authority in Psychedelic Misconduct

○ Labate, B C , & Cavnar, C (Eds ) (2014) Ayahuasca Shamanism in the Amazon and Beyond Oxford University Press

○ Fotiou, E (2020) The Globalization of Ayahuasca Shamanism and the Erasure of Indigenous Shamanism Anthropology of Consciousness, 31(2), 164–185

○ Evans, J., & Adams, J. H. (2025). Guruism and Cultic Social Dynamics in Psychedelic Practices and Organisations.

Risk Factors References

● Emotional Vulnerability: Trauma May Be at the Surface

○ Oram, M. (2018). The trials of psychedelic therapy: LSD psychotherapy in America JHU Press

○ Malone, T C , Mennenga, S E , Guss, J , Podrebarac, S K , Owens, L T, Bossis, A P, & Ross, S (2018) Individual experiences in four cancer patients following psilocybin-assisted psychotherapy Frontiers in pharmacology, 9, 335252.

○ Rose, J. R. (2024). Memory, trauma, and self: Remembering and recovering from sexual abuse in psychedelic-assisted therapy Journal of Psychedelic Studies, 8(3), 336-348

○ Preller, K H , Herdener, M , Pokorny, T, Planzer, A , Kraehenmann, R , Stämpfli, P, & Vollenweider, F X (2017) The fabric of meaning and subjective effects in LSD-induced states depend on serotonin 2A receptor activation. Current Biology, 27(3), 451-457.

○ Preller, K H , & Vollenweider, F X (2018) Phenomenology, structure, and dynamic of psychedelic states Behavioral neurobiology of psychedelic drugs, 221-256

○ Roseman, L , Haijen, E , Idialu-Ikato, K , Kaelen, M , Watts, R , & Carhart-Harris, R. (2019). Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. Journal of psychopharmacology, 33(9), 1076-1087.

○ Mithoefer, M C , et al (2011) MDMA-assisted psychotherapy for post-traumatic stress disorder: A randomized controlled pilot study Journal of Psychopharmacology, 25(4), 439-452 [Available at Sage Journals]

○ Carhart-Harris, R L , et al (2014) The entropic brain: A theory of conscious states informed by neuroimaging research with psychedelic drugs. Frontiers in Human Neuroscience, 8, Article 20. [Available at Frontiers]

○ Carhart-Harris, R L , Leech, R , Williams, T M , Erritzoe, D , Abbasi, N , Bargiotas, T, & Nutt, D J (2012) Implications for psychedelic-assisted psychotherapy: functional magnetic resonance imaging study with psilocybin The British Journal of Psychiatry, 200(3), 238-244

● Heightened Neuroplasticity: The Stakes are Higher

○ De Vos, C. M., Mason, N. L., & Kuypers, K. P. (2021). Psychedelics and neuroplasticity: a systematic review unraveling the biological underpinnings of psychedelics Frontiers in psychiatry, 12, 724606

○ Calder, A E , & Hasler, G (2023) Towards an understanding of psychedelic-induced neuroplasticity Neuropsychopharmacology, 48(1), 104-112

○ Nardou, R., Lewis, E. M., Rothhaas, R., Xu, R., Yang, A., Boyden, E., & Dölen, G. (2019). Oxytocin-dependent reopening of a social reward learning critical period with MDMA Nature, 569(7754), 116-120

○ Nardou, R , Sawyer, E , Song, Y J , Wilkinson, M , Padovan-Hernandez, Y, de Deus, J L , & Dölen, G (2023) Psychedelics reopen the social reward learning critical period Nature, 618(7966), 790-798

● Increased Responsivity to Practitioner Influence and Tendencies to take on Devotee Role

○ Lifshitz, M , et al (2022) Suggestibility during altered states of consciousness: A comprehensive review Frontiers in Psychology, 13, Article 789234 [Available at Frontiers]

○ Oliver, A , Wong, A , Chen, E , & Raz, A (2024) Suggestibility and psychedelics: From therapeutics to social context. Psychology of Consciousness: Theory, Research, and Practice.

○ Dolder, P. C., Müller, F., Schmid, Y., Borgwardt, S. J., & Liechti, M. E. (2018). Direct comparison of the acute subjective, emotional, autonomic, and endocrine effects of MDMA, methylphenidate, and modafinil in healthy subjects Psychopharmacology, 235, 467-479

○ Schmid, Y., Enzler, F., Gasser, P., Grouzmann, E., Preller, K. H., Vollenweider, F. X., ... & Liechti, M. E. (2015). Acute effects of lysergic acid diethylamide in healthy subjects. Biological psychiatry, 78(8), 544-553.

○ Nour, M M , Evans, L , Nutt, D , & Carhart-Harris, R L (2016) Ego-dissolution and psychedelics: validation of the ego-dissolution inventory (EDI) Frontiers in human neuroscience, 10, 269

○ Carhart-Harris, R. L., et al. (2015). Neural correlates of the LSD experience revealed by multimodal neuroimaging. Proceedings of the National Academy of Sciences, 113(17), 4853-4858. [Available at PubMed]

○ Lebedev, A V, et al (2015) Reduced ego-boundaries in the psychedelic state Human Brain Mapping, 36(8), 3137-3153 [Available at Wiley]

○ Preller, K H , Schilbach, L , Pokorny, T, Flemming, J , Seifritz, E , & Vollenweider, F. X. (2018). Role of the 5-HT2A receptor in self-and other-initiated social interaction in lysergic acid diethylamide-induced states: a pharmacological fMRI study Journal of Neuroscience, 38(14), 3603-3611

○ Ko, K , Knight, G , Rucker, J J , & Cleare, A J (2022) Psychedelics, mystical experience, and therapeutic efficacy: A systematic review Frontiers in psychiatry, 13, 917199

○ Dupuis, D. (2021). Psychedelics as tools for belief transmission. set, setting, suggestibility, and persuasion in the ritual use of hallucinogens. Frontiers in psychology, 12, 730031

○ Evans, J , & Adams, J H (2025) Guruism and Cultic Social Dynamics in Psychedelic Practices and Organisations

○ Hassan, S (2018) The Cult of Trump: A Leading Cult Expert Explains How the President Uses Mind Control. Free Press.

○ Noorani, T (2020) Contested epistemics: Participant experiences of epistemic injustice in psychedelic research trials Sociology of Health & Illness, 42(3), 672-688 [Available at Wiley]

● Compromised Cognition & Decision-Making

○ Yousefi, P., Lietz, M. P., O’Higgins, F. J., Rippe, R. C., Hasler, G., van Elk, M., & Enriquez-Geppert, S. (2025). Acute effects of psilocybin on attention and executive functioning in healthy volunteers: a systematic review and multilevel meta-analysis Psychopharmacology, 1-26

○ Pokorny, T, Duerler, P, Seifritz, E , Vollenweider, F X , & Preller, K H (2020) LSD acutely impairs working memory, executive functions, and cognitive flexibility, but not risk-based decision-making. Psychological medicine, 50(13), 2255-2264.

○ Carhart-Harris, R. L., & Friston, K. J. (2019). REBUS and the anarchic brain: toward a unified model of the brain action of psychedelics Pharmacological reviews, 71(3), 316-344

Misconduct Typology References

Sexual Misconduct References

Below are key standards and guidelines reaffirming the prohibition of sexual relationships with clients:

● American Psychological Association (APA) Ethics CodeL Sections 10 05–10 08 prohibit sexual relationships with current clients and impose a minimum two-year waiting period post-therapy, with strict documentation to ensure non-exploitation

● National Association of Social Workers (NASW) Code of Ethics: Section 1.09 categorically forbids sexual activities or contact with both current and former clients, emphasizing the enduring power imbalance

● American Medical Association (AMA) Code of Medical Ethics: Opinion 9.1.1 underscores the physician-patient power disparity and warns against any sexual or romantic contact, including post-treatment

● American Counseling Association (ACA) Code of Ethics: Prohibits sexual relationships with current clients; requires a minimum five-year gap post-termination to address continuing power differentials (Sections A 5 a–A 5 d)

● Multidisciplinary Association for Psychedelic Studies (MAPS) Code of Ethics: Explicitly prohibits any sexual contact between psychedelic therapists and participants, both during and indefinitely after treatment.

● International Center for Ethnobotanical Education, Research & Service (ICEERS): Prohibits all forms of sexual or romantic relationships between facilitators and participants, acknowledging increased vulnerability in ceremonial settings.

● International Society for Psychedelic Research (ISPR) Ethics Framework: Highlights the amplified risks of sexual misconduct in altered states and recommends stringent boundaries for practitioners.

● British Association for Counselling and Psychotherapy (BACP) Ethical Framework: Condemns sexual or romantic relationships with current clients, recognizing the profound trust and dependency inherent in therapeutic work (Sections 22 & 23)

● Oregon Psilocybin Services Program (OAR 333-333-5050): Establishes that sexual misconduct with clients constitutes grounds for immediate license revocation due to heightened risks in altered states

● European Federation of Psychologists’ Associations (EFPA) Meta-Code of Ethics: Advises against sexual relationships with clients, emphasizing the international consensus on preventing therapist-client sexual boundary violations

● Johnson, M. W., Richards, W. A., & Griffiths, R. R. (2008). Human Hallucinogen Research: Guidelines for Safety, in the Journal of Psychopharmacology: Discusses the amplified vulnerability in psychedelic states, stressing strict ethical protocols to prevent all forms of exploitation, including sexual.

● Boundaries, Professionalism, and Malpractice in Psychiatry

● APA on boundary violations

● APA Procedures for Handling Grievances and Complaints of Unethical Conduct

● Group for the Advancement of Psychiatry on Boundaries:

Violations Of Consent And Coercion References

● American Medical Association (AMA) Code of Ethics: Establishes patients’ fundamental right to make decisions about their care, requiring documented consent for every intervention

● American Psychological Association (APA) Ethics Code: Mandates informed consent in therapeutic relationships and prohibits creating dependency or exerting undue pressure

● World Medical Association’s Declaration of Helsinki: Requires voluntary participation and explicitly outlaws coercion in all forms of medical or research interventions.

● The Nuremberg Code: Categorically mandates voluntary consent without any form of force, deceit, or coercion in human experimentation

● American Counseling Association (ACA) Code of Ethics: Explicitly prohibits coercion in therapeutic contexts and requires documented informed consent

● National Association of Social Workers (NASW) Code of Ethics: Upholds client self-determination and forbids overriding client autonomy except for documented immediate safety concerns

● American Nurses Association (ANA) Code of Ethics: Affirms a patient’s right to refuse any intervention and prohibits pressuring them to accept treatment

● Multidisciplinary Association for Psychedelic Studies (MAPS) Code of Ethics: Prohibits pressuring participants under altered states and requires explicit protocols for informed consent.

● American Society of Addiction Medicine (ASAM) Guidelines: Requires collaborative decision-making for dosage changes and prohibits any form of practitioner pressure in substance use interventions

● International Center for Ethnobotanical Education, Research & Service (ICEERS) Code: Calls for respect of participant autonomy and forbids pressuring them into additional ceremonies or treatments.

Abandonment References

● American Medical Association (AMA) Code of Ethics Prohibits patient abandonment and requires practitioners to offer adequate notice and resources for continuing care, especially in high-risk settings.

● American Psychological Association (APA) Ethics Code Identifies abandonment as a serious ethical violation and mandates continuous presence during vulnerable or altered states (Sections 3.04 & 10.09).

● U.S. Food and Drug Administration (FDA) Guidelines for Psychedelic Research Require continuous participant monitoring, specifying protocols for practitioner presence throughout the session to ensure safety and swift intervention.

● American Psychiatric Association Guidelines Emphasize constant observation during altered states, disallowing practitioners to leave participants unattended, particularly in clinical or research settings.

● Association of State and Provincial Psychology Boards (ASPPB) Mandates continuous care and supervision for clients in vulnerable states, reinforcing that leaving a client during a potentially disorienting session constitutes abandonment.

● Multidisciplinary Association for Psychedelic Studies (MAPS) Code of Ethics Explicitly prohibits leaving participants unattended during psychedelic therapy, requiring practitioners to maintain consistent presence and promptly address arising concerns.

● International Center for Ethnobotanical Education, Research & Service (ICEERS): Stresses continuous monitoring in ceremonial contexts, warning that facilitator absence during peak or integration phases can endanger participant welfare.

Physical Abuse References

● National Association of Social Workers (NASW) Code of Ethics: Explicitly prohibits any form of physical violence or abuse against clients (Standard 1.01) and requires documented justification for any necessary contact.

● American Psychological Association (APA) Ethics Code: Mandates safeguarding client safety (Principle A: Beneficence and Nonmaleficence) and expressly forbids actions that cause physical harm

● American Medical Association (AMA) Code of Ethics: Requires detailed disclosure and explicit consent before undertaking any procedure likely to cause physical discomfort (Opinion 1 1 3)

● Multidisciplinary Association for Psychedelic Studies (MAPS) Code of Ethics: Emphasizes participant safety, continuous monitoring, and respect for bodily autonomy during all phases of a psychedelic session

● American Psychiatric Association (APA): Calls for explicit protocols to protect individuals in altered states, including guidelines to prevent harm from physical contact or restraint (Practice Guideline for the Psychiatric Evaluation of Adults)

Fraud References

Professional and research organizations, as well as many Traditional and indigenous organizations emphasize strict standards against misrepresentation:

● American Medical Association (AMA) Code of Medical Ethics: Requires thorough disclosure of any substances used in treatment and mandates informed consent regarding their risks and benefits (Opinion 1.1.3).

● U.S. Food and Drug Administration (FDA) Regulations: Enforce accurate labeling and representation of all therapeutic compounds, including specifications for purity and composition (21 CFR Part 201).

● Multidisciplinary Association for Psychedelic Studies (MAPS) Code of Ethics: Requires full disclosure of substance composition and testing for research, as well as honest representation of training and qualifications.

● American Pharmacists Association (APhA) Guidelines: Emphasize complete transparency about medication composition, effects, and potential interactions

● American Psychological Association (APA) Ethics Code: Prohibits misrepresentation of professional competence (Sections 5.01–5.03) and requires accurate communication about outcomes (Principle B)

● National Association of Social Workers (NASW) Code of Ethics: Mandates honesty in all advertising, representation of services, and qualifications (Standard 4.06).

● Federal Trade Commission (FTC) Truth-in-Advertising Standards: Prohibit unsubstantiated or misleading therapeutic claims; require that advertised benefits be backed by evidence

● Oregon Psilocybin Services (OAR 333-333-5000): Specifies that practitioners must not use deceptive advertising, misrepresent credentials, or falsely claim that psilocybin services guarantee certain outcomes

Financial Exploitation References

● American Psychological Association (APA) Ethics Code: Standard 6 04: Fees and Financial Arrangements Requires that fees be established in advance, transparent, and not exploitative

● National Association of Social Workers (NASW) Code of Ethics: Standard 1 13: Payment for Services. Prohibits soliciting excessive fees or financial arrangements that exploit client vulnerability.

● American Medical Association (AMA) Code of Medical Ethics: Opinion 11 2 3: Fee Splitting Warns against referral or financial arrangements that exploit the patient’s vulnerability or trust in the physician

● American Counseling Association (ACA) Code of Ethics: Section A 10: Fees and Business Practices. Requires accurate representation of fees, prohibits accepting goods or services in lieu of payment if it harms the client, and bans exploitative financial practices

● MAPS' Code of Ethics explicitly prohibits any financial transactions during altered states and requires all financial arrangements to be established before psychedelic sessions

● Federal Trade Commission (FTC): Truth-in-Advertising Standards: Prohibits unsubstantiated claims regarding outcomes or benefits in any therapeutic or spiritual practice, including hidden fees or misleading pricing structures.

● Oregon Psilocybin Services (OAR 333-333-4100): Requires transparent, itemized fees disclosed before psilocybin services Practitioners can face license revocation for exploitative or coercive financial practices

● British Association for Counselling and Psychotherapy (BACP) Ethical Framework: Emphasizes the importance of transparency regarding all fees and the avoidance of monetary arrangements that could compromise client welfare.

● The International Center for Ethnobotanical Education, Research & Service (ICEERS) guidelines prohibit financial exploitation and require transparent fee structures before any medicine work

Duel Relationships References

● American Counseling Association (ACA) Code of Ethics, Section A.5: Mandates caution in dual relationships, warning of the potential for harm and conflicts of interest

● MAPS Code of Ethics: Advises against multiple overlapping relationships to protect participants from undue influence

Discrimination References

● American Psychological Association (APA) Ethics Code: Prohibits discrimination and mandates cultural competency (Principle E)

● National Association of Social Workers (NASW) Code of Ethics: Requires cultural awareness and prohibits discriminatory practices (1 05)

● American Medical Association (AMA) Code of Ethics: Emphasizes equal treatment regardless of patient characteristics

● MAPS Code of Ethics: Mandates equitable access and culturally informed care

● International Center for Ethnobotanical Education, Research & Service (ICEERS): Emphasizes respect for cultural diversity and equitable access to care

● Oregon Psilocybin Services Guidelines: Requires non-discrimination and cultural competency training

Negligence References

● American Psychological Association (APA) Ethics Code, Principle A: Practitioners must work to prevent harm and respond appropriately in emergencies.

● International Center for Ethnobotanical Education, Research & Service (ICEERS): Calls for clear safety protocols and thorough participant screening.

● American Society of Addiction Medicine (ASAM) Guidelines: Emphasize the importance of practitioner sobriety and fitness for duty, highlighting that clinicians providing care under the influence violate professional standards. ASAM.org - Clinical Practice Guidelines

● American Psychiatric Association (APA) Guidelines: Advocate proper screening for psychiatric conditions prior to any mind-altering interventions and caution against combining medications or psychoactive substances without expert oversight. Psychiatry.org - Practice Guidelines

● U.S. Food and Drug Administration (FDA) Good Clinical Practice (GCP) Guidelines: Specify that investigators must maintain rigorous standards for substance storage, labeling, and participant safety monitoring in any clinical research setting. FDA.gov - Guidance Documents

● Multidisciplinary Association for Psychedelic Studies (MAPS) Code of Ethics: Prohibits facilitators from being under the influence of substances in ways that compromise participant safety and mandates thorough screening protocols. MAPS.org - Code of Ethics

● American Psychological Association (APA) Ethics Code: Highlights the importance of competence and fitness to practice, requiring that professionals do not practice while

compromised by personal issues or impairments (Standard 2.06). APA.org - Ethical Principles of Psychologists and Code of Conduct

● Johns Hopkins Psychedelic Research Unit Guidelines: Recommend extensive screening, strict dosing protocols, and a prepared response plan for potential adverse events. Reference: Johnson, M. W., Richards, W A., & Griffiths, R. R. (2008). Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology, 22(6), 603–620.

● Chacruna Institute Guidelines: Emphasize ethical, safe practices for ceremonies, including thorough participant screening and caution against mixing multiple psychoactive plants or substances. Chacruna.net - Best Practices & Guidelines

Breach Of Confidentiality References

● National Association of Social Workers (NASW) Code of Ethics (Standard 1.07): Strict requirements to safeguard client confidentiality

● American Medical Association (AMA) Code of Ethics (Opinion 3 2 1): Requires confidentiality to protect patient privacy.

Unsafe Physical Environment References

● U.S. Food and Drug Administration (FDA) Guidelines for Clinical Trials: Emphasize ensuring participant safety through adequate infrastructure, emergency procedures, and risk management plans. Reference: FDA.gov – Good Clinical Practice (GCP) Guidelines.

● Multidisciplinary Association for Psychedelic Studies (MAPS) Code of Ethics: Requires a safe, controlled environment for psychedelic therapy sessions, including continuous monitoring and hazard-free surroundings Reference: MAPS org – Code of Ethics

● American Psychological Association (APA) Ethics Code: Encourages practitioners to maintain environments conducive to client welfare, avoiding any conditions that place clients at risk (Sections 3.04 & 3.06). Reference: APA.org – Ethical Principles of Psychologists and Code of Conduct.

Verbal Abuse References

● American Psychological Association (APA) Ethics Code: Requires respectful, non-abusive communication (Sections 3 04 & 3 01)