Ethical Touch in Psychedelic-Assisted Therapy: Moving From Theory to Practice
As the field grows, ethical touch in psychedelic-assisted therapy is becoming an increasingly important topic for clinicians, researchers, and regulators. In a new article, my colleague Jenna LeJeune, PhD, and I—both of Portland Psychotherapy Clinic, Research, & Training Center and the Portland Institute for Psychedelic Science—make the case that consent and assent in psychedelic therapy need clearer definitions, and that psychedelic-assisted therapy safety depends on practical, measurable guidelines for touch.
Touch can play many roles in therapy. In some contexts, a therapist may use limited supportive touch, such as holding a hand or touching a shoulder, to offer comfort or grounding. In psychedelic-assisted therapy, however, touch becomes more ethically complex because clients may be in altered states of consciousness. Psychedelics can affect decision-making, shift momentary preferences, and increase vulnerability. For this reason, I believe ethical frameworks must move beyond general principles and become specific enough to guide real clinical practice.
Why Consent Alone May Not Be Enough
One of the central distinctions is between consent and assent. Consent refers to a decision made when a person has full decision-making capacity. Assent refers to agreement given when capacity may be limited or altered, while still respecting the person's autonomy as much as possible.
In psychedelic-assisted therapy, consent should be obtained before the psychedelic is administered, while the client is in an ordinary state of consciousness. During the psychedelic session itself, the client may assent to touch that was already discussed and agreed upon in advance, or they may revoke prior consent. However, requests for new forms of touch that go beyond what was previously consented to should not be honored while the client is under the influence.
This model creates an important safeguard. It allows clients to retain choice and autonomy during the session, while also recognizing that altered states may affect their ability to make new decisions about touch.
Four Types of Touch
We also propose a clearer framework for categorizing touch. Rather than relying only on the therapist's intended purpose, we recommend considering the intensity, intrusiveness, and conventionality of the touch.
The first category is safety-related touch. This includes physical contact needed to protect the client's physical safety, such as preventing a fall, taking vital signs, or securing a heart-rate monitor. We describe this type of touch as non-optional because it is part of maintaining safety during treatment.
The second category is supportive touch. This refers to limited, gentle contact to commonly touched areas of the body, such as the hand, forearm, or shoulder, intended to offer comfort, support, or connection. This type of touch requires both prior consent and in-session assent.
The third category is bodywork. This includes more intensive or intimate forms of nonsexual touch, such as manipulating the body or providing physical resistance for therapeutic purposes. We argue that this type of touch requires not only client consent and assent, but also specialized therapist training.
The final category is sexual touch, which is never ethically permissible in psychedelic-assisted therapy.
Training, Culture, and Research
Therapist training must address cultural, identity, and diversity factors. Touch does not carry the same meaning for every person or across every culture. For some people, touch may feel comforting. For others, especially those with histories of trauma, oppression, or violence, touch may feel threatening or coercive. Ethical training must help therapists understand these differences and avoid assuming that one approach fits everyone.
I also want to highlight a major gap in the research: there are very few empirical studies on touch in psychotherapy, and none specifically examining touch in psychedelic-assisted therapy. We need both quantitative and qualitative research to understand how clients experience touch and how touch may help or harm.
Moving Toward Evidence-Based Guidelines
I feel strongly that ethical discussions about touch need to become more practical. Clinicians need clear categories, consent procedures, training standards, and ways to measure client experiences. Without these tools, ethical touch remains too abstract to reliably guide practice.
As psychedelic care continues to develop, ethical touch in psychedelic-assisted therapy will require more than good intentions. Strong consent and assent in psychedelic therapy can help protect client autonomy, while clearer training and research can strengthen psychedelic-assisted therapy safety. Moving from theory to practice means building evidence-based guidelines that maximize potential benefits while protecting clients from harm.
Author: Jason Luoma, PhD
About the Author
Jason Luoma, PhD, is the Director of Research at the Portland Institute for Psychedelic Science (PIPS) and a co-founder of Portland Psychotherapy. His work focuses on psychedelic-assisted therapy, shame, and Acceptance and Commitment Therapy (ACT). He also hosts the Research Matters Podcast, where he interviews researchers about their work.