Psychedelic medicine (New Rochelle, N.Y.)Oct 22, 2026

The role of patient-therapist connection in psilocybin treatment for hard-to-treat depression: a critical comment

Psychedelic Science Weekly Brief ↗PubMed ↗DOI ↗

Updated Oct 23, 2026

Abstract

The interpretation of therapeutic alliance's role in psilocybin treatment for treatment-resistant depression may not be adequately supported by the reported results.

The conclusion that therapeutic alliance did not significantly impact treatment efficacy is questioned due to methodological concerns.
Observed associations suggest that therapeutic alliance may influence both the psychedelic experience and clinical outcomes.
Methodological weaknesses in the analysis could obscure relevant effects related to therapeutic alliance.
Deviations from the study protocol were noted, indicating potential issues that require further investigation.
Accurate characterization of psychological and contextual factors is essential in psychedelic treatment research.

Simplified

This commentary critically examines the interpretation and analytic choices in Goodwin and colleagues' recent analysis of therapeutic alliance in psilocybin treatment for treatment-resistant depression. While the authors conclude that alliance did not meaningfully contribute to treatment efficacy, we argue that this interpretation is not supported by the reported results, which are, in addition, shaped by methodological decisions that obscure relevant effects. By contextualizing the observed associations, clarifying the logic of mediation analysis, and pointing out methodological weaknesses, we show that the available evidence is more consistent with a meaningful role of therapeutic alliance in shaping both the psychedelic experience and clinical outcomes. Furthermore, we highlight unexplained deviations from the study protocol that warrant scrutiny. These concerns underscore the importance of accurately characterizing psychological and contextual factors in psychedelic treatment research and call for more comprehensive and transparent analyses of psychotherapeutic processes.

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The role of patient-therapist connection in psilocybin treatment for hard-to-treat depression: a critical comment

Abstract

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