How People Experience Healing Touch During Psilocybin Therapy

Touch in psychotherapy has a complex history, originating with Freud who initially used touch but later discouraged it, emphasizing analytic neutrality in the “talking cure” of psychoanalysis (Ben‐Shahar 2018; Phelan 2009). Modern psychotherapy largely defines itself as a “non‐touching profession” (C. Harrison et al. 2012). While sexual contact is prohibited (e.g. Australian Psychological Society [APS] 2016a), guidelines on other forms of touch (e.g. task‐oriented, attentional, celebratory; see Hunter and Struve 1998 for a taxonomy) are sparse beyond limited recognition of the value of reassuring gestures like handshakes or arm touches (APS 2016b, 2016c). Advocates of physical touch in psychotherapy stress its importance in human development and attachment, healing, and strengthening therapeutic relationships (Durana 1998). Modalities such as somatic therapy, Gestalt therapy, and eye movement desensitization and reprocessing therapy employ touch (Hase 2021; Hunter and Struve 1998; Kepner 2001; Kuhfuß et al. 2021), but robust empirical research is lacking. Contemporary PAT trials share features with standard psychotherapies—therapeutic alliance, supportive environments, and client engagement (Gründer et al. 2023; Gukasyan and Nayak 2022; Wolff et al. 2024). However, PAT protocols also introduce unique considerations tied to psychedelic dosing sessions.

Therapeutic touch in PAT typically proposes to enable therapeutic support where verbal communication is either not possible or risks undermining inner‐focus during the psychedelic experience. Psychedelics can profoundly alter awareness (Hirschfeld and Schmidt 2020) that can be psychologically challenging (Barrett et al. 2016), making psychotherapeutic support essential during dosing sessions (Johnson et al. 2008). Yet psychedelics transiently impair linguistic capacity (Wießner et al. 2023) and induce “indescribable” experiences (Griffiths et al. 2016) that risk being disrupted by communication attempts (Sanz et al. 2021; Wießner et al. 2023). Accordingly, non‐conversational therapeutic strategies may be needed during acute psychedelic effects. Some clinicians consider touch a useful non‐verbal tool, but empirical evidence and research into participants’ attitudes are scarce. This study addresses that gap.

Touch was used since the first wave of PAT (1950s–1970s). While some clinicians advocated maternal‐style physical holding (Martin 1957), others cautioned against non‐essential contact during altered states (Buckman 1967). Current PAT manuals permit physical touch (Guss et al. 2020; Haden 2019; Mithoefer 2017), yet definitions range from minimal distress support (e.g., handholding) to somatic‐style interventions (Kuhfuß et al. 2021; Rosendahl et al. 2021). Despite increasing clinical and public interest in PAT (Luoma et al. 2023; McLane et al. 2021), and a growing literature on the ethical delivery of therapeutic touch (Neitzke‐Spruill et al. 2025), the safety, utility, or acceptability of touch in PAT to participants has not been directly investigated.

The use of touch in PAT raises significant ethical considerations. These include consent‐related power imbalances; the risk that touch is experienced as sexual or boundary‐violating; professional boundary consequences; and cultural or personal differences (T. R. Harrison 2023; Simon 1999; Smith et al. 1998; Zur 2007, 2). High‐profile misconduct cases in PAT amplify these concerns (C. Harrison et al. 2012; Buisson, in Kay Ross and Nickles 2023), as do reports of increased dependency on therapists (Kay Ross and Nickles 2023). Another ethical concern is whether patients can meaningfully consent to touch while under the influence of consciousness‐altering drugs. Acute psychedelics effects include increased confusion, transient cognitive‐perceptual distortion, increased suggestibility and increased meaning‐making (Carhart‐Harris et al. 2015; Grahl Johnstad 2021; Hartogsohn 2018; Kaelen et al. 2015; Preller et al. 2017). These characteristics may increase the risks that touch causes discomfort or is misinterpreted. Attempts to address these risks include the use of therapist dyads and formal consent protocols (McLane et al. 2021; Harlow, 2013, as cited in Passie 2018).

Given its prevalence, vague definition, and ethical complexity, understanding how participants experience therapeutic touch is critical. This study explores these perspectives qualitatively in a large psilocybin‐assisted therapy trial for Generalized Anxiety Disorder (GAD) by asking:

This research was approved by the Monash University Human Research Ethics Committee. Data were collected from a randomized clinical trial (Psi‐GAD‐1) of PAT for severe GAD (for study details see ACTRN12621001358831). Treatment included two dosing sessions (psilocybin 25–30 mg or diphenhydramine 75–100 mg) and nine psychotherapy sessions with a mixed‐gender co‐therapy team. Drug administration sessions followed standard clinical trial procedures, including individual dosing in a comfortable university laboratory setting, under the supervision of a co‐therapy team.

The trial permitted minimal, supportive touch (e.g., handholding) during dosing sessions, mainly for managing distress. Non‐contact supports included weighted blankets and hot water bottles. Somatic psychotherapy was not permitted; sexual or sensual touch was prohibited. Consent was established and practiced before dosing, and participants could adjust their preferences between sessions. This protocol aimed to uphold boundaries and promote a safe, respectful therapeutic environment. All trial participants consented to therapeutic touch with personalized specifications, and all but one participant analyzed qualitatively received therapeutic touch.

This study used qualitative and descriptive data collected via survey and interview (Figure 1).

Participant ratings of the importance of therapeutic touch for n = 72 participants (following psilocybin administration during the control phase or open label extension) are presented in Figure 2.

Participants’ engagement with touch was highly idiosyncratic, reflected in both qualitative and descriptive data. The high mean rating of touch importance (m = 75.38), and negatively skewed distribution (nine participants gave a maximum rating) suggest that most valued touch. Yet the wide range (min = 23; max = 100; see Figure 2) indicates that not all participants found touch important, reinforcing the need for tailored rather than universal protocols. Qualitative data similarly reflected generally positive attitudes alongside variability in expectations, utilization during dosing sessions, and perceived helpfulness.

Participants used touch to manage emotions, navigate psychedelic states, and pursue broader therapeutic goals. Although consistent with positive attitudes to touch in pure psychotherapy contexts (Horton et al. 1995), our findings suggest that touch may synergize with key aspects of the acute psychedelic experience. Participants described the usefulness of touch in managing heightened emotional intensity and a foreign state of consciousness, both key aspects of the acute psychedelic experience (Barrett et al. 2016; Hirschfeld and Schmidt 2020; Roseman et al. 2019). Findings also highlight challenges for the use of touch in PAT: while no participants reported significantly adverse effects, touch may distract from meaningful experiences, vary in appropriateness across the acute drug effect stage, or paradoxically intensify, rather than grounding, emotions. While PAT manuals regularly incorporate therapeutic touch (Guss et al. 2020; Haden 2019; Mithoefer 2017), few have characterized these benefits and challenges, which are critical for informing strategic clinical use.

While some literature suggests that touch may strengthen the therapeutic alliance (Berendsen 2018; Horton et al. 1995), participants here emphasized the reverse—that a strong alliance was a prerequisite for touch. Establishing a safe, predictable setting through robust consent processes seemed to enhance confidence and trust, supporting both the use of touch and the broader therapeutic relationship, which in turn may enhance therapeutic outcomes (Grof, 1980; Phelps, 2017).

The positive shifts in some participants’ views of touch after psilocybin suggest they may initially underestimate its value in PAT. While ethical concerns have been raised about withholding touch during psychedelic states (Haden 2019; Mithoefer 2017), this did not arise in our sample, likely due to high consent rates supported by flexible consent procedures. High consent and positive attitudes are not surprising given favorable attitudes toward touch in psychotherapy (Tanzer et al. 2022), but may reflect sample‐specific traits (e.g., high trait‐agreeableness or complex attachment histories; Cervera‐Solís et al. 2022). Given the difficulty of predicting its value, inviting participants to predefine “emergency‐only” touch could ensure supportive options are available if needed (McLane et al. 2021). For those declining touch, non‐contact supports (e.g., weighted blankets, synchronized breathing, physical proximity) may offer similar benefits. Future work could examine views of those who do not receive touch, examine the individualized “journey” of touch experiences across dosing sessions, and investigate systems for informed consent and strategic use of touch.

Post‐dosing discussions about therapeutic touch, regardless of whether it was used, proved valuable. Touch constitutes a boundary crossing, as it departs from standard psychological practice (Aravind et al. 2012). One participant described a group‐hug during a difficult dosing experience, which, while positive for them, is potentially a higher‐risk application of touch. While such moments require clinical judgment, intuition alone cannot reliably ensure safety and should be seen as a last resort. Structured debriefing offers a harm reduction measure, helping to prevent boundary crossings from becoming boundary violations by clarifying consent, reinforcing autonomy, and prompting therapist reflection (Gutheil 2008). Similarly, informed consent should also address the potential for varied interpretations of touch under psychedelics.

The benefits and challenges of therapeutic touch in PAT will likely vary by clinical indication, psychedelic compound, and therapeutic context. Participant perspectives on touch varied within and between participants, and similar variability is expected across other populations (e.g., those with trauma histories may have distinct needs; Strauss et al. 2019). Our study is limited by the same sampling homogeneity observed across PAT research (Haft et al. 2025); investigating diverse cultural frameworks surrounding touch is essential. Further research should also explore how touch interacts with faster‐acting (Strassman and Qualls 1994) or empathogenic compounds (De Wit and Bershad 2020); these results are specific to psilocybin.

Our study involved a minimalistic, client‐directed touch protocol with detailed consent, contrasting with approaches involving extensive bodywork or somatic methods (Haden 2019; Mithoefer 2017). While our findings justify therapeutic touch as a tool to foster support, connection, and grounding, we caution against treating it as an active intervention during acute psychedelic states until further evidence and ethical guidance are established. Protocols involving more intensive physical contact likely carry increased risks and should be implemented only with clear transparency, adequate training, and rigorous monitoring.

Future research should examine PAT therapists’ needs and challenges regarding touch. These insights could inform training programs for emerging practitioners and guide the safe, effective use of therapeutic touch, while addressing the ethical balance between therapist and patient autonomy.

Due to the identifiable nature of the qualitative data, it has not been made publicly available. However, efforts have been made to ensure transparency by providing extensive illustrative quotes (including counterexamples) within the text and supplementary materials.