Atlas›Domain VII · Transpersonal, psychedelic & altered states›Guide 068
Guide VII-068

Psychedelic group therapy

Anderson, Lewis, Dames, Kryskow2020
A 44 · L 40 · M 1630 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: there is no single manual for this. The guide puts together three published trial or programme versions, plus one regulated non-medical frame. (1) The UCSF psilocybin-assisted group therapy model for older long-term AIDS survivors (Anderson et al., 2020, EClinicalMedicine; registered protocol NCT02950467, version 1.3, April 2018), built on Brief Supportive-Expressive Group Therapy (SEGT). Where the registered protocol and the published paper differ, the paper's delivered schedule is followed. (2) The Utah HOPE group-dosing model for cancer-related depression (Lewis et al., 2023, J Pain Symptom Manage; observations paper in J Psychedelic Studies, 2023; NCT04522804). (3) The Roots To Thrive group ketamine-assisted "Community of Practice" model (Dames, Kryskow, Tsang & Argento, 2025, Front Psychiatry). (4) Oregon's state-regulated group administration sessions under the adopted OAR 333-333 rules, as amended with effect from 1 January 2026. The Sunstone community cancer-centre cohort trial (Agrawal et al., Cancer, 2024; NCT04593563) appears only as reported second-hand. Group integration circles for people who used substances outside clinics are covered as harm reduction. [source: Anderson 2020; NCT02950467 protocol; NCT04522804 registry record; Dames 2025; OHA/OPS 2025; Godasi 2019/2021]

Sources include: the full exclusion criteria of the UCSF protocol (registered protocol document), HOPE and Agrawal/Sunstone (registry records via the Blossom mirror) and the Roots To Thrive end-of-life study (registry record); Oregon's current group-session, preparation and facilitator-conduct rules (OAR 333-333-5020, 5120 and 5230, as amended to 1 January 2025) plus the OPS rulemaking letter of November 2025. Secondary only: the HOPE observations paper (abstract and summary page), the Agrawal trial's room arrangement (news report and abstract excerpt), and FDA, Canadian and European status as of mid to late 2026 (news and legal-guide sources). Not confirmed: the Agrawal primary paper's full methods and Canadian section 56 exemptions [uncertain].

What it is. Psychedelic group therapy is a format, not one therapy. It covers protocols that place a psychedelic or dissociative medication session inside a group-psychotherapy container, with group preparation, group (and usually individual) integration, and sometimes co-located dosing of a cohort on the same day. The published versions differ in where the group sits. In the UCSF model, preparation and integration happen in the group but the medication session is individual. In HOPE, preparation, dosing and integration all take place together as a cohort, with a therapist for each participant. In Roots To Thrive, a 12-week community of practice surrounds the medicine sessions. [source: Anderson 2020; Lewis 2023; Dames 2025]

Core idea of change. The authors locate change in the combination of the drug experience with group processes: mutual support, shared meaning-making, peer validation and reduced isolation. Supportive-expressive group work (here-and-now processing, emotional expression, facing death and loss) carries themes forward before and after the session. Roots To Thrive states the position explicitly: "Ketamine is positioned as an amplifier, not the primary driver of change"; the community itself is the main mechanism. HOPE therapists noted that shared anticipation followed by shared relief produced a fast, strong bond, and participants described their individual stories as connecting. [source: Anderson 2020; Dames 2025; Lewis et al., J Psychedelic Stud 2023]

Safety rule for this guide. No doses, routes, drug schedules, sourcing or combinations appear anywhere. Medical monitoring is described only as a responsibility of medical staff. This guide is for clinicians working inside legal, regulated or approved trial programmes, or providing integration and harm reduction to people who used substances elsewhere. It does not support facilitating illegal use.

2. Framework

Published architectures

  • A. Group psychotherapy with individual medication sessions (UCSF / Anderson 2020). Sequential cohorts of six participants, each with two co-therapists. Over about seven weeks: about 3 h of individual psychotherapy, 12–15 h of group psychotherapy, and an individual full-day medication session in which at least one of the participant's own group co-therapists serves as one of the two guides. Pre-session groups ran 90 min, twice weekly, for about two weeks. Post-session groups increased from four (cohort 1) to six (cohorts 2–3) after participant feedback. [source: Anderson 2020] Version note: the registered protocol (v1.3, April 2018) planned weekly 90-min groups led by two co-facilitators using a modified Brief SEGT manual: four groups, then the individual medication session, then further groups, ten groups in all. The published paper reports the schedule actually delivered. [source: NCT02950467 protocol]
  • B. Fully group model with co-located dosing (HOPE / Lewis 2023). Cohorts of 4–6 (12 participants across three cohorts). Three 120-min group preparation sessions, each with about 90 min of group work and 30 min of individual breakout time with the participant's own therapist. Then a group medication session in a shared clinical suite, with each participant–therapist dyad in a semi-private bay and a lead therapist coordinating. Then three 120-min group integration sessions over two weeks. About 20 h per participant in total. [source: PsyPost 2023 summary; Lewis et al., J Psychedelic Stud 2023 (via abstract page)]
  • B′. Cohort dosing with adjacent rooms (Agrawal et al., Sunstone Therapies, community cancer centre). A phase II open-label trial with 30 participants who had cancer and major depressive disorder. Cohorts of 3–4 were treated on the same day in adjacent rooms that were open to each other, with one therapist per participant. Preparation and integration were done in groups. No treatment-related serious adverse events were reported, and the C-SSRS showed no suicidality. [source: ASCO Post, Dec 2023, reporting Agrawal et al., Cancer, doi:10.1002/cncr.35010; abstract excerpt of the earlier research letter, Agrawal et al., JAMA Oncol 2023;9(6):864–866, via Drug Policy Facts] A companion qualitative paper reports participants' exit interviews (Beaussant et al., Cancer, doi:10.1002/cncr.35024). [source: ASCO Post 2023] [uncertain: primary paper; number and length of preparation and integration sessions not reported]
  • C. Group ketamine-assisted Community of Practice (Roots To Thrive / Dames 2025). Cohorts of 20–40 split into fixed small groups of 6–9, led by a facilitator pair or trio, with roughly one facilitator for every 3–4 participants. Twelve weekly sessions, each with a large-group segment (30–40 min) and a small-group segment (70–90 min). Several medicine sessions are embedded mid-programme; the protocol sets their timing, which is not reproduced here. Physician oversight, registered nurses, facilitators (therapists, somatic practitioners, psychologists), and Indigenous Elders or cultural guides where relevant. [source: Dames 2025]
  • D. Regulated non-medical group administration (Oregon Psilocybin Services, OAR 333-333). Group administration sessions are allowed under the adopted rules (OAR 333-333-5230, group administration sessions; OAR 333-333-5020, group preparation). Current rule text (amended effective 1 January 2025): the number of facilitators required depends on the amount each client will consume, and the largest amount in the group sets the ratio for everyone (amounts not given here); a group may have no more than 25 clients or the room's maximum occupancy, whichever is smaller; the room must let everyone take part without touching or coming into close contact with others, with at least 25 square feet per person, and must let a facilitator monitor every client; clients may not touch one another except permitted supportive touch with prior written consent; each client must be offered the chance to ask for one-to-one support from a facilitator; a disruptive client is moved, with reasonable efforts, to a separate part of the administration area; and every client must be present when the session begins. [source: OAR 333-333-5230] Group preparation must cover safety in a group: other clients' adverse reactions, boundaries, a consent model for interacting with other clients and touch between clients; outdoor groups may have to stay outdoors whatever an individual prefers. Clients must be able to meet every facilitator beforehand and to reschedule with another group or facilitator. [source: OAR 333-333-5020] From 1 January 2026, an amendment to OAR 333-333-5020 removed the earlier requirement that clients have the chance to meet the other group members before a group session. [source: OPS rulemaking letter, Nov 2025] Every client must have a preparation session before any administration session. It covers intake, the OPS informed-consent document, the client bill of rights, accessibility needs, a Client Safety and Support Plan, and a transportation plan. Facilitators must use a nondirective approach; supportive touch is limited to hugs or hands placed on a client's hands, feet or shoulders, only when the client asks and has given prior written consent; any romantic or sexual contact with a client is prohibited. The facilitator must contact each client within 72 hours afterwards and offer information on optional integration sessions. [source: OAR 333-333-5120; OHA/OPS 2025]
  • E. Group integration circles (post-hoc, any route of prior experience). Peer or clinician-led circles for people who have already had a psychedelic experience. No substances, and sober attendance only. [source: Godasi 2019/2021]

Phases, goals and movement criteria

  1. Referral and screening. Goal: safe, suitable, reasonably homogeneous cohort. UCSF: phone screen, in-person consent and enrolment visit, structured diagnostic interview (SCID-5 and SCID-5-PD), and exclusion criteria "adapted from current standard criteria for psilocybin administration". HOPE: referrals from oncology, palliative care and social work; chart review, clinician contact, phone call, in-person psychiatric and medical evaluation with depression and suicide-risk measures (PHQ-9, C-SSRS). Prohibited medications are withdrawn under medical supervision before registration (HOPE: at least five half-lives). Roots To Thrive: referral by a licensed provider, RN interview, physician medical evaluation, questionnaires, psychiatric evaluation if indicated. Move on when medically and psychiatrically cleared and consented. The full UCSF and HOPE exclusion lists are given below under "Published eligibility and exclusion criteria". [source: Anderson 2020; NCT02950467 protocol; Lewis J Psychedelic Stud 2023; NCT04522804 record; Dames 2025]
  2. Individual preparation. Goal: trust, rapport, individual psychoeducation and consent. UCSF: a 90-min meeting with both assigned co-therapists. Oregon: a mandatory preparation session before any administration session, covering intake, informed consent, the client bill of rights, accessibility, a Client Safety and Support Plan and transport home. Roots To Thrive: a private physician consultation. Move on when the individual relationship is established. [source: Anderson 2020; OHA/OPS 2025; Dames 2025]
  3. Group preparation. Goal: cohesion, shared agreements, skills for the session (breathing, mindfulness, self-compassion), intention setting, orientation to the setting. Move on when all preparatory components are complete. Roots To Thrive makes this mandatory before the first medicine session, together with acknowledgement of intake agreements. UCSF measured demoralisation after the fourth group. [source: Anderson 2020; Lewis 2023; Dames 2025] [synthesis: also check that each member can name an intention, use a grounding skill, and say what they will do if distressed]
  4. Medication-session day. Goal: a safe, supported experience. Structured settling-in; non-directive support by the assigned therapist; a shared or individual music frame; medical monitoring by medical staff. Move on when the participant is steady. Roots To Thrive keeps participants in the room until steady and gives a written post-session safety sheet, a named driver and a 24-hour no-driving rule. [source: Lewis J Psychedelic Stud 2023; Dames 2025]
  5. Integration. Goal: meaning-making and carrying change into daily life. UCSF: a 2-h individual visit the next day, then group sessions. HOPE: three group sessions. Roots To Thrive: small-group processing, mixed-cohort integration meetings, journaling and alumni programming. [source: Anderson 2020; Lewis 2023; Dames 2025]
  6. Follow-up and alumni. Roots To Thrive offers alumni programming and optional refresher sessions. UCSF ran participant focus groups that fed back into the protocol. [source: Dames 2025; Anderson 2020]

Published eligibility and exclusion criteria (registered protocols)

These are the programmes' own lists, paraphrased. Medical items are decided by the medical team. They are given here so the therapist knows what screening covers and can refer appropriately.

  • UCSF (NCT02950467, protocol v1.3, 2018). Inclusion: gay-identified men aged 50 or over, HIV diagnosed before 1996, moderate-to-severe demoralisation on the Demoralization Scale-II, able to consent. Exclusion: life expectancy under six months; poor functional status on the Palliative Performance Scale; cognitive impairment on the MoCA, or a neurodegenerative diagnosis; regular use of antidepressants, anxiolytics, stimulants, antipsychotics, anti-epileptics, cannabis or systemic corticosteroids within two weeks of enrolment (low-dose tricyclics for neuropathic pain excepted), with these avoided during the study and analgesics and alcohol restricted around session days; personal history of psychotic or bipolar disorder (SCID-5), or a family history in a first- or second-degree relative; a current severe major depressive episode (referred to standard care); active suicidal ideation with intent in the past six months, or a suicide attempt in the past five years with lethality indicators (C-SSRS); moderate-to-severe narcissistic personality disorder (SCID-5-PD); moderate or severe hallucinogen use disorder, or hallucinogen persisting perception disorder; seizure disorder; CNS metastases or symptomatic CNS infection; clinically significant cardiovascular disease, prolonged QTc, or uncontrolled hypertension or tachycardia; need for supplemental oxygen; insulin-dependent or poorly controlled diabetes; inadequate liver or kidney function; specific drug interactions, including one antiretroviral; and any condition the investigators judge unsafe, or that makes the person unsuitable for group therapy. [source: NCT02950467 protocol]
  • HOPE (NCT04522804, University of Utah / Huntsman Cancer Institute). Inclusion: aged 25 or over; current cancer diagnosis, in treatment or within 26 weeks of finishing; life expectancy of at least three months; DSM-5 depressive disorder, including adjustment disorder with depressed mood; no regular antidepressant or anxiolytic (including benzodiazepine) for at least four weeks; English fluency and sufficient literacy for consent; performance status ECOG 2 or better; a support person to take them home after dosing; adequate liver function; pregnancy test and contraception requirements; agreement to avoid other psychoactive substances, supplements and non-routine medications around the session (stable opioid pain regimens allowed under conditions). Exclusion: COVID-19 infection or exposure; systemic antidepressant, antipsychotic or anxiolytic use within four weeks; personal or immediate-family history of schizophrenia, bipolar disorder, delusional or schizoaffective disorder or other psychotic illness; current dissociative disorder, or another psychiatric condition judged incompatible with rapport or safe exposure; current Cluster B personality disorder; substance use disorder (caffeine and nicotine excepted) currently or in the past two years; severe depression needing immediate standard care such as hospitalisation; suicidal ideation with active intent or plan; CNS involvement of the cancer or other major CNS disease; another investigational cancer treatment; paraneoplastic syndrome or ectopic hormone production; uncontrolled significant illness (including advanced heart failure, unstable angina, recent heart attack, uncontrolled hypertension, prolonged QTc or serious arrhythmia, reduced kidney function, active hepatitis B or C); known severe hypersensitivity to the product; prohibited medications without a washout of at least five half-lives; and any other condition, including social or psychological issues, that the investigator judges a contraindication. [source: NCT04522804 registry record via Blossom trial page]
  • Agrawal / Sunstone (NCT04593563, sponsor Maryland Oncology Hematology). Inclusion: aged 18 or over; current DSM-5 major depressive disorder (a single episode lasting at least three months), confirmed by records, clinical assessment and the MINI; a malignant cancer diagnosis; HAM-D17 of 18 or more at screening and baseline; not taking an antidepressant, antipsychotic or medical cannabis at screening; able to complete assessments and visits; capacity to consent. Exclusion: current or past schizophrenia, psychotic, bipolar, delusional, paranoid or schizoaffective disorder, or borderline personality disorder; alcohol or drug use disorder in the past year; significant suicide risk (C-SSRS item 4 or 5, or suicidal behaviour, in the past year, or clinical judgement); circumstances judged incompatible with rapport or safe participation; pregnancy or breastfeeding; stroke or heart attack, uncontrolled hypertension or significant arrhythmia within a year; uncontrolled or insulin-dependent diabetes; seizure disorder; positive drug screen (case by case); another investigational study within 30 days; clinically significant abnormal examination, ECG or laboratory findings; other significant medical illness; psychedelic use in the past 12 months or during the current episode; current or recent chemotherapy or radiation that significantly impairs physical function. [source: registry record via the Blossom trial mirror]
  • Roots To Thrive. Referral by a licensed provider, RN interview, physician medical evaluation and psychiatric evaluation where indicated. [source: Dames 2025] Its registered end-of-life feasibility study (NCT05958758; Roots to Thrive Society with Island Health and Vancouver Island University, Nanaimo) lists: inclusion of adults 19–80 with a terminal diagnosis, adequate performance status and kidney and liver function, and emotional distress not adequately helped by other treatment; exclusion for pregnancy or breastfeeding; regular use of interacting medications (managed only by the study physician); prior sensitivity or significant adverse reaction to psychedelics; uncontrolled epilepsy, cardiovascular or vascular disease, or unstable insulin-dependent diabetes; cancer involving the central nervous system and certain hormone-producing tumours; depression or anxiety needing immediate medication (referred to community psychiatry); current or past schizophrenia, other non-substance psychotic disorder, or bipolar I or II disorder (borderline personality disorder and bipolar disorder considered only after psychiatric consultation); a dissociative disorder; ongoing intoxication; unstable housing; and a first-degree relative with bipolar disorder or schizophrenia. Whether the same list applies to its other group programmes is not stated [uncertain]. [source: NCT05958758 registry record via ICH GCP mirror]
  • Oregon. There is no fixed diagnostic exclusion list for clients. Facilitators must decide whether they can serve a client and may refer elsewhere, and the preparation session includes client-specific risk planning. [source: OAR 333-333-5120; OHA/OPS 2025]

What these lists share [synthesis from the four full lists above]: personal (and often family) history of psychotic or bipolar illness; current high suicide risk; certain personality disorders; recent substance use disorder; serious uncontrolled cardiovascular, CNS or seizure conditions; and interacting psychiatric medications, which are managed only by medical staff. UCSF explicitly allowed exclusion for unsuitability for group therapy, and Roots To Thrive's study also excludes dissociative disorders and unstable housing.

Legal and regulatory status (as of the sources' dates)

  • Australia: from 1 July 2023, MDMA (for PTSD) and psilocybin (for treatment-resistant depression) are Schedule 8 when prescribed by TGA-authorised specialist psychiatrists. Prescribing requires an HREC-approved treatment protocol. Both remain unapproved medicines and are otherwise Schedule 9. A June 2026 TGA checklist changed supervision requirements. [source: Astris Law, July 2026]
  • United States. Psilocybin and MDMA remain federally Schedule I, and ketamine is Schedule III. Neither psilocybin nor MDMA is FDA-approved as of the sources' dates. FDA declined to approve Lykos's MDMA-assisted therapy for PTSD in August 2024 (complete response letter, after a 9–2 advisory committee vote against). One legal guide reports that the company (renamed Resilient Pharmaceuticals) resubmitted in August 2026. Compass Pathways' psilocybin for treatment-resistant depression reported two positive phase 3 trials (June 2025 and February 2026), holds Breakthrough Therapy designation, received a National Priority Voucher in April 2026, and was targeting a rolling new drug application in late 2026. An executive order of 18 April 2026 directs agencies to speed psychedelic research and review and widen Right-to-Try, but it approves no drug and does not reschedule. Legal clinical access is through trials and FDA expanded access. Oregon has run state-regulated psilocybin services since its 2020 law (group sessions allowed under OAR 333-333), and Colorado voters created a regulated "healing centre" framework in 2022. [source: Medical Daily, June 2026; Mind Medicine Law, Sept 2026 (secondary); OHA/OPS 2025; Recovered.org (Colorado, secondary)] [uncertain: the Lykos/Resilient resubmission is reported without a primary source; check FDA announcements for any decision after June 2026]
  • Canada and Europe. Canada: MDMA and psilocybin are Schedule I under the CDSA. Access is case-by-case through Health Canada's Special Access Program, for serious conditions where conventional treatment has failed, and approvals have reportedly fallen since early 2024. [source: Mind Medicine Law, Sept 2026, secondary] [uncertain: section 56 exemptions and current numbers not verified] Germany: since August 2025, a BfArM-supported compassionate-use programme gives adults with treatment-resistant depression access to psilocybin therapy at specialised centres (Mannheim, Berlin). MDMA has no therapeutic access outside research. Czech Republic: from 1 January 2026, psychiatrists and psychotherapists may use psilocybin under controlled clinical conditions at qualified facilities, for conditions such as cancer-related depression and serious depression when registered treatments have failed or are not tolerated. Switzerland: the Federal Office of Public Health can grant exceptional, case-by-case permissions for therapeutic use; this is not a general access route. Netherlands: psilocybin truffles are sold legally, but there is no approved psilocybin therapy and MDMA is prohibited. No EU-wide (EMA) approval exists. New Zealand: in September 2026, Medsafe approved two named psychiatrists to prescribe MDMA for PTSD. [source: Psychedelic Health, Dec 2025; Mind Medicine Law, Sept 2026; Recovered.org (Switzerland), all secondary] None of these frameworks is described as group-specific, so group formats depend on each programme's protocol. [synthesis]
  • Outside these frames, group use is illegal in most jurisdictions. The clinician's role there is integration and harm reduction only (see Interventions 25–26).

3. Guiding principles

  • Build homogeneous, small cohorts. UCSF chose a shared identity (gay-identified OLTAS men) to create "relatively homogenous group therapy cohorts" that build trust fast. HOPE recommends small cohorts and deliberate screening. In practice: compose groups around a shared life situation, and keep group size within what your team can individually track. [source: Anderson 2020; Lewis J Psychedelic Stud 2023]
  • Keep one-to-one contact inside the group. HOPE kept therapist–participant dyads and treated individual breakout time as essential, advising that it be preserved even if ratios are reduced. In practice: every member has a named therapist and private time with them in every phase. [source: Lewis J Psychedelic Stud 2023]
  • Behave consistently because suggestibility is raised. HOPE cautions that therapists should act consistently to avoid inadvertent coercion, and cites recent reports of abuse in psychedelic therapy as a reason for deliberate protocol design. In practice: the same rules, touch policy and language for everyone, with no improvising boundaries on the day. [source: Lewis J Psychedelic Stud 2023]
  • Give non-directive support during the session. HOPE therapists gave non-directive, supportive interventions on dosing day. In practice: follow the participant's lead, reassure, and do not steer content. [source: PsyPost 2023]
  • Work in the here and now, with mutual support and emotional expression. These are SEGT core elements as adapted by UCSF. In practice: turn members toward one another and toward what is felt in the room now. [source: Anderson 2020; Spiegel, Stanford SEGT page]
  • Detoxify death and face existential themes directly. SEGT aims to help members confront fears of dying openly rather than avoid them, and to reorder life priorities. In practice: name mortality, loss and meaning plainly when they arise. [source: Stanford SEGT page; Anderson 2020]
  • The community is the mechanism; the medicine amplifies. In practice: invest most of your time in the group container, not the drug day. [source: Dames 2025]
  • Keep membership consistent and pace to trust. Roots To Thrive keeps small-group membership fixed. Facilitators model vulnerability and pace sharing to the group's level of trust. In practice: no rotating members, and no pushing disclosure. [source: Dames 2025]
  • Co-create the agreements. Shared agreements are drafted in the first small group and refined to consensus; they foster accountability. In practice: the group owns the rules, and you refer back to them. [source: Dames 2025]
  • Prepare people for the setting. HOPE found that describing the setting in advance, walk-throughs, and explicit framing of the shared playlist helped. A clinical room can be softened deliberately. In practice: no surprises on the day. [source: Lewis J Psychedelic Stud 2023]
  • Get touch consent in advance and confirm it on the day. Roots To Thrive collects touch preferences beforehand and reconfirms them on a form and visible whiteboard. Oregon's adopted rules allow only supportive touch (hugs or hands on a client's hands, feet or shoulders) when the client asks and has given prior written consent, bar clients from touching one another except permitted supportive touch with prior written consent, and require space so everyone can take part without touching or close contact. [source: Dames 2025; OAR 333-333-5120 and 5230] In practice: written, specific consent, checked again before and during any contact, revocable at any moment, never sexual, and visible to the whole team.
  • The right to step out. Oregon requires that each client in a group session be offered the chance to ask for one-to-one support from a facilitator. HOPE kept a private breakout room. In practice: a person can always leave the group frame without penalty. [source: OAR 333-333-5230; Lewis 2023]
  • Use trauma-informed, somatic, relational and culturally responsive practice. Roots To Thrive combines Western clinical frameworks with Indigenous knowledge and Elder involvement where appropriate. Indigenous participants asked for relational authenticity and Indigenous team members. In practice: cultural elements are led by people who hold that authority, never borrowed by the clinician. [source: Dames 2025]
  • Involve the community and adapt from feedback. UCSF consulted OLTAS community experts in the design and changed the protocol in real time from DSMB and focus-group feedback (e.g. adding post-session groups). In practice: build in structured feedback and act on it. [source: Anderson 2020]
  • Monitor safety at every contact. UCSF ran an adverse-event interview and suicide-risk screen (C-SSRS) at every visit. In practice: risk review is a standing item, not a crisis response. [source: Anderson 2020]
  • Peer circles are not therapy. Integration-circle facilitators should not attempt to deliver therapy, should not steer content except to correct factual errors, and should refer when needed. In practice: be clear whether you are running therapy or a peer space. [source: Godasi 2019/2021]

4. Intervention inventory

The sources describe the group frame at the level of components, not scripted session plans. Steps below follow those components. Where step-level detail is mine, it is marked [synthesis]. All example language is illustrative.

1. Screening and cohort composition

  • Purpose / when: before enrolment. Selects people who are medically and psychiatrically suitable and who will cohere as a group. [source: Anderson 2020; Lewis J Psychedelic Stud 2023; Dames 2025]
  • Steps:
    1. Take referrals from treating teams: oncology, palliative care, social work or HIV services, or a licensed provider (Roots To Thrive). [source: Lewis 2023; Anderson 2020; Dames 2025]
    2. Phone screen, then chart review and contact with the treating clinician. [source: Lewis 2023; Anderson 2020]
    3. In-person evaluation: structured psychiatric interview (UCSF used SCID-5 and SCID-5-PD), standardised measures (e.g. PHQ-9, a demoralisation scale, C-SSRS, and at UCSF also cognitive and functional screens), and a physician medical evaluation. Apply the programme's published exclusion criteria (see section 2, "Published eligibility and exclusion criteria"). Medical staff handle any withdrawal of interacting medications. [source: Anderson 2020; NCT02950467 protocol; NCT04522804 record; Dames 2025]
    4. Decide group fit: shared life situation or identity, and capacity to tolerate other people's distress and differing experiences. UCSF's protocol lets investigators exclude anyone judged unsuitable for group therapy. [source: Anderson 2020 (homogeneity rationale); NCT02950467 protocol (group-suitability exclusion); synthesis for the capacity criterion]
    5. Note prior psychedelic use. UCSF did not exclude lifetime use, because doing so made recruitment unfeasible. [source: Anderson 2020]
  • Example language (illustrative): "This programme is done as a group, so part of what we're checking is whether being with others who are going through something similar feels workable for you, not only whether it's medically safe."
  • Watch for: a candidate whose main difficulty is interpersonal hostility, active substance relapse, or high suggestibility to group pressure. Consider individual treatment instead. [synthesis] Homogeneity can exclude people. State the cohort criteria openly. [synthesis]

2. Individual preparation and rapport meeting

  • Purpose / when: before the group starts. Builds trust with the specific therapists who will guide the session. [source: Anderson 2020]
  • Steps: (1) Meet each participant with both assigned co-therapists. UCSF allowed 90 min. (2) Explore history, reasons for joining and hopes. (3) Give individual psychoeducation on group therapy and on the medication experience. (4) Cover practical and consent matters privately, including touch preferences and anything the person does not want raised in the group. [source: Anderson 2020; synthesis for item 4]
  • Example language (illustrative): "We'll be with you in the group and on the day itself, so today is about you getting a sense of us, and us of you."
  • Watch for: working alliance with both therapists. Rapport with only one is a risk if that one is unavailable on the day. [synthesis]

3. Group psychoeducation and informed-consent review

  • Purpose / when: early preparation. Gives a shared understanding of what will happen, the risks, the rules and the legal status. [source: Dames 2025 (mandatory 1-h group education and consent review); Anderson 2020]
  • Steps: (1) Walk through the programme timeline. (2) Describe typical effects, including challenging experiences, in plain terms without dosing detail. (3) Explain safety procedures, medical staff roles and emergency plans. (4) Explain the touch policy, confidentiality, and the right to ask for one-to-one support, switch to an individual format or withdraw. In Oregon group preparation must also cover other clients' adverse reactions, boundaries, a consent model for interacting with other clients, and touch between clients. (5) Have participants acknowledge intake agreements. (6) Answer questions in the group; take private concerns to individual time. [source: Dames 2025; OAR 333-333-5020 and 5230; synthesis for ordering]
  • Example language (illustrative): "Some people have hard stretches during the session: fear, grief, feeling confused. That's expected, and it's why someone will be beside you the whole time."
  • Watch for: members repeating others' expectations ("everyone gets a mystical experience"). Correct them early. [synthesis]

4. Co-creating group agreements

  • Purpose / when: first small-group meeting. Creates safety and accountability. [source: Dames 2025]
  • Steps: (1) Invite proposals: confidentiality, respectful communication, no advice-giving unless asked, phones off, attendance, no contact about substances outside the programme [synthesis for content beyond confidentiality and respect, which Godasi names]. (2) Write them up visibly. (3) Refine until there is consensus. (4) Read them aloud or display them at subsequent meetings. [source: Dames 2025; Godasi 2019/2021]
  • Example language (illustrative): "What would you need from each other to say something real in here?"
  • Watch for: silent members. Check agreement with each person by name. Revisit the agreements when they are breached. [synthesis]

5. Opening and closing breathing and guided meditation

  • Purpose / when: every group session (UCSF: about 5 min at the start and the end). Grounds members and rehearses skills they can use during the medication session. UCSF replaced SEGT's self-hypnosis component with this. [source: Anderson 2020]
  • Steps: (1) Invite a comfortable posture. (2) Guide slow, attentive breathing. (3) Add a brief self-compassion or mindfulness focus. (4) At the close, repeat briefly to help members transition out. [source: Anderson 2020; synthesis for steps]
  • Example language (illustrative): "Notice the breath arriving and leaving… if a hard feeling is here, see if you can offer yourself the kindness you'd offer a friend."
  • Watch for: trauma survivors who find closed eyes or breath focus activating, a known adverse effect of contemplative practice. Offer eyes-open and external-anchor options. [synthesis]

6. Check-in and check-out (sensations and emotions)

  • Purpose / when: start and end of each small group (Roots To Thrive). Builds interoceptive awareness and lets the group register who is present. [source: Dames 2025]
  • Steps: each member names one or two body sensations and one or two emotions, without explanation. Go round the circle. No cross-talk. Repeat at the close. [source: Dames 2025]
  • Example language (illustrative): "Just the words, no story: maybe 'tight chest, tired, a bit hopeful.'"
  • Watch for: stories creeping in. Gently return to the format. Change between check-in and check-out is useful process data. [synthesis]

7. Intention setting

  • Purpose / when: preparation. Orients each person's experience and gives the group shared reference points. [source: Lewis J Psychedelic Stud 2023; Godasi (intentions round)]
  • Steps: (1) Invite each member to reflect on what they hope to understand or meet, not a demanded outcome. (2) Share in the group. (3) Refine in individual breakout. (4) Revisit at integration. [source: Lewis 2023; synthesis for steps 3–4]
  • Example language (illustrative): "Rather than a goal, think of a question you're bringing, something you'd like to be open to."
  • Watch for: rigid intentions that set people up to feel they "failed". Frame intentions as orientation, not a contract. [synthesis]

8. Supportive-expressive here-and-now processing

  • Purpose / when: the core of every preparation and integration group (UCSF adapted Brief SEGT). [source: Anderson 2020; Stanford SEGT page]
  • Steps: (1) Open the floor. (2) Turn members toward each other ("Who else knows this?"). (3) Invite direct expression of feeling in the room. (4) Link individual stories to shared themes. (5) Encourage mutual support over therapist advice. [source: Anderson 2020 (here-and-now, mutual support, emotional expression); synthesis for the micro-steps]
  • Example language (illustrative): "You've told us about the loss. What's happening for you right now, saying it out loud here?"
  • Watch for: the group drifting into information exchange. Bring it back to feeling. Working looks like members responding to each other unprompted. [synthesis]

9. Detoxifying death and existential discussion

  • Purpose / when: illness- or loss-focused groups (cancer, long-term AIDS survival). Turns avoided fears about dying, survival and meaning into speakable material. [source: Anderson 2020; Stanford SEGT page; Lewis 2023 (existential discussion)]
  • Steps: (1) Name mortality and loss directly when they appear. (2) Explore the specific fears (pain, being a burden, dying alone). (3) Move to reordering priorities and hope within limits. (4) Address communication with family and with medical teams. [source: Stanford SEGT page (themes); synthesis for sequence]
  • Example language (illustrative): "Several of you have circled around dying today. Can we talk about it directly: what scares you most?"
  • Watch for: suicidal ideation emerging. Assess it in the standard way (C-SSRS was used at every visit). Respond to hopelessness with meaning-oriented work, not reassurance alone. [source: Anderson 2020; Stanford SEGT page (life-affirming response); standard risk practice]

10. Guided imagery / mindfulness practice

  • Purpose / when: preparation (HOPE named mindfulness or guided imagery among its components). Rehearses letting go and staying with experience. [source: Lewis J Psychedelic Stud 2023]
  • Steps: (1) Brief settling. (2) A guided image of approaching rather than avoiding something difficult (e.g. moving toward a wave rather than away from it). (3) Debrief in the group. [synthesis: the HOPE scripts are not published in the sources cited]
  • Example language (illustrative): "If something frightening appears, imagine turning toward it and asking what it wants you to know."
  • Watch for: members who cannot visualise. Offer body-based or auditory alternatives. [synthesis]

11. Environmental orientation and playlist framing

  • Purpose / when: before dosing day. Reduces fear and surprise, and frames shared elements. [source: Lewis J Psychedelic Stud 2023; Dames 2025]
  • Steps: (1) Walk the cohort through the room in advance; HOPE found a walk-through before enrolment helpful. (2) Show the seating (bays, recliners, mats), comfort items (eyeshades, blankets, pillows) and breakout room. (3) Explain the music: HOPE used a communal speaker playlist to emphasise shared experience; Roots To Thrive used room speakers plus individual headsets. Explain that eyeshades are optional. (4) Soften the clinical space deliberately and add agreed rituals. [source: Lewis 2023; Dames 2025]
  • Example language (illustrative): "The music will be the same for everyone. Some of it you may not like, and that's part of being in this together. If it ever feels unbearable, tell your therapist."
  • Watch for: requests for personal music choice or no eyeshades. HOPE recommends making both explicit choices in preparation. [source: Lewis 2023]

12. Touch-preference consent procedure

  • Purpose / when: preparation, reconfirmed on the day. Prevents boundary violations under heightened suggestibility. [source: Dames 2025; OAR 333-333-5120 and 5230]
  • Steps: (1) Agree specific permitted supportive touch (e.g. a hand on the shoulder, holding a hand), or none, in writing in advance. In Oregon, facilitator touch is limited to hugs or hands on a client's hands, feet or shoulders, given only when the client asks and has given prior written consent, and clients may not touch each other except permitted supportive touch with prior written consent. (2) Reconfirm it on the day on a form. (3) Display it on a whiteboard so the whole team knows. (4) Ask again before any touch during the session; stop at once if the person says no or signals stop, and never expand the agreement during the session. (5) Arrange space so participants do not touch each other. Touch is never sexual. [source: Dames 2025; OAR 333-333-5120 and 5230; synthesis for step 4]
  • Example language (illustrative): "Earlier you said a hand on your shoulder would be OK. Is that still true right now?"
  • Watch for: consent that is given to please the therapist. Make "no" easy and normal. [synthesis]

13. Individual breakout time within group sessions

  • Purpose / when: each preparation session (HOPE: about 30 of 120 min). Builds the dyad and allows individual narrative work. [source: Lewis J Psychedelic Stud 2023]
  • Steps: (1) After the group segment, pairs separate into private spaces. (2) Review personal history, fears and intentions. (3) Rehearse what the participant wants from the therapist during the session. (4) Return to a brief closing. [source: Lewis 2023; synthesis for steps 2–4]
  • Example language (illustrative): "In the group you mentioned your father. Is that something you'd want me to know more about before the day?"
  • Watch for: material too private for the group. Agree what stays in the dyad. [synthesis]

14. Family and friends sessions

  • Purpose / when: at three points in the Roots To Thrive programme. Brings the support network into the process. In SEGT, "fortifying families and friends" is a stated theme. [source: Dames 2025; Stanford SEGT page]
  • Steps: (1) Invite nominated supporters. (2) Explain the programme and what changes they may see. (3) Explain how to support without pressuring for disclosure. (4) Brief them on post-session safety, e.g. the named driver role. [source: Dames 2025 (sessions and named driver); synthesis for content]
  • Example language (illustrative): "Your person may want to talk about it, or may not. Listening without fixing is usually the most helpful thing."
  • Watch for: supporters who are themselves a source of harm. Consent from the participant comes first. [synthesis]

15. Medication-session day: arrival and settling-in

  • Purpose / when: the start of the medication day. Calms anticipation and re-establishes the container. [source: Lewis J Psychedelic Stud 2023 (structured settling-in); Dames 2025]
  • Steps: (1) Welcome the cohort together; HOPE included the wider team to build cohesion. (2) Medical staff complete pre-session checks; this is their responsibility and is not described here. (3) Reconfirm touch consent and intentions. (4) A grounding opening; Roots To Thrive uses an Elder's invitation or a reflective reading. (5) Participants settle into their bays or rooms with their therapist. [source: Lewis 2023; Dames 2025]
  • Example language (illustrative): "We've prepared together for this. Whatever comes today, you're not on your own with it."
  • Watch for: anticipatory anxiety spreading. Name it as shared and normal. [synthesis]

16. Dyad conduct during the session (non-directive support)

  • Purpose / when: throughout the session. Gives safe, attuned presence without steering. [source: PsyPost 2023 (HOPE non-directive, supportive interventions); Anderson 2020 (own co-therapist as one of two guides)]
  • Steps: (1) Sit near the participant at their eye level. (2) Offer brief verbal reassurance when anxiety rises. UCSF found verbal reassurance often eased severe anxiety. (3) Invite the person to stay with experience and use the rehearsed breath skills. (4) Respond to requests (water, blanket, eyeshades off). (5) Keep your own talk minimal, and never interpret content for the participant during the session. (6) Use only pre-consented touch, asking first. [source: Anderson 2020; PsyPost 2023; Dames 2025; synthesis for steps 1, 3 and 5]
  • Example language (illustrative): "You're safe. I'm right here. You can let it move through."
  • Watch for: paranoia, agitation, or medical signs. Hand over to medical staff at once. UCSF reduced stimulation for one participant with paranoia by darkening the room and adjusting the music. [source: Anderson 2020]

17. Lead therapist role

  • Purpose / when: in co-located group dosing. One clinician coordinates group process, safety and logistics, and offers some objective distance. [source: Lewis J Psychedelic Stud 2023]
  • Steps: (1) Hold an overview of all bays. (2) Track noise and distress levels across the room. (3) Decide on use of the breakout room. (4) Coordinate breaks and contact with medical staff. (5) Support dyads under strain. (6) Lead the closing gathering. [source: Lewis 2023; synthesis for 2–6]
  • Example language (illustrative, to a co-therapist): "Bay 3 is getting loud. Do you want me to sit with you for a bit?"
  • Watch for: the lead being pulled into one dyad and losing the overview. Have a back-up lead. [synthesis]

18. Holding a distressed participant inside the group space

  • Purpose / when: when one member is struggling during a co-located session. HOPE had a private breakout room but never used it. When one participant found the playlist intolerable, their dyad supported them in the group space, and the participant later valued the shared process. [source: Lewis J Psychedelic Stud 2023]
  • Steps: (1) The dyad therapist intensifies presence and reassurance. (2) The lead checks whether others are being affected. (3) Offer, but do not insist on, the breakout room. (4) Debrief the experience in integration as a shared event if the person agrees. [source: Lewis 2023; synthesis for 2–4]
  • Example language (illustrative): "You can stay right here with us, or we can go somewhere quieter together. Both are fine."
  • Watch for: distress spreading to other members (not addressed in the sources). See section 5. [synthesis]

19. Session close and safe discharge

  • Purpose / when: end of the medication day. Ensures a safe transition home. [source: Dames 2025]
  • Steps: (1) Participants stay until steady; medical staff confirm. (2) An optional brief closing gathering. (3) Give the written post-session safety sheet. (4) Release only to the named driver or escort, with a no-driving rule for 24 h. (5) Confirm the integration appointment. [source: Dames 2025; synthesis for 2 and 5]
  • Example language (illustrative): "Tonight, go gently. No big decisions, and call the number on the sheet if anything worries you."
  • Watch for: pressure to share the experience before the person is ready. [synthesis]

20. Next-day individual integration

  • Purpose / when: the day after the session (UCSF, 2 h with a clinician). Reviews what happened and begins to "generate meaning from the experience" for daily life. [source: Anderson 2020]
  • Steps: (1) Let the participant tell the experience in their own words. (2) Clarify confusing or frightening parts. (3) Identify themes they want to take into the group, and what they want to keep private. (4) Run an adverse-event and risk check. [source: Anderson 2020; synthesis for 3]
  • Example language (illustrative): "Start wherever it starts for you. What stays with you most from yesterday?"
  • Watch for: distress, flashbacks or sleep disturbance. UCSF recorded one unexpected PTSD flashback. [source: Anderson 2020 via Chacruna]

21. Group integration sessions

  • Purpose / when: after the session (UCSF: four, then six groups; HOPE: three 120-min groups over two weeks). Shares experiences, explores personal narratives, and carries change into daily life. [source: Anderson 2020; PsyPost 2023]
  • Steps: (1) Opening practice and check-in. (2) Each member shares as much as they choose. (3) The facilitator links themes across members; HOPE noted that group integration amplified dosing-day themes. (4) Peers validate. UCSF found peer validation helped members process shame, for example about sexual abuse. (5) Move from story to action: what will be different this week. (6) Close. [source: Anderson 2020; Lewis 2023; synthesis for steps 1, 5 and 6]
  • Example language (illustrative): "What did you hear in each other's stories that you recognise in your own?"
  • Watch for: members comparing experiences ("mine wasn't as deep"). See section 5. [source: Lewis 2023]

22. Compassionate witnessing sharing circle

  • Purpose / when: Roots To Thrive small groups. Members attune to the speaker without judgement and reflect their own felt sense rather than advise. [source: Dames 2025]
  • Steps: (1) The speaker shares. (2) Listeners stay quiet and attuned. (3) Listeners may say what they noticed in their own body or emotions while listening. (4) No fixing or interpreting. Pace to trust. [source: Dames 2025; synthesis for 3]
  • Example language (illustrative): "As you spoke, I noticed my throat getting tight. Something in it moved me."
  • Watch for: reflections that become advice. Redirect to the listener's own felt sense. [synthesis]

23. Journaling

  • Purpose / when: between sessions (Roots To Thrive). Captures material for integration. [source: Dames 2025]
  • Steps: suggest brief entries after each medicine session and each group: images, feelings, insights, actions. Members bring what they choose to the group. [synthesis for structure]
  • Example language (illustrative): "Write it down before it fades. Even three lines is enough."
  • Watch for: journaling used to ruminate. Shift the focus to actions. [synthesis]

24. Mixed-cohort integration meetings and alumni programme

  • Purpose / when: after each medicine session and after the programme (Roots To Thrive). Widens peer support and maintains change. [source: Dames 2025]
  • Steps: (1) Run periodic meetings that mix small groups or cohorts. (2) Offer alumni groups and optional refresher sessions within the programme's protocol. [source: Dames 2025]
  • Example language (illustrative): "Alumni groups are a place to check in on what's held and what's slipped."
  • Watch for: dependence on the group. Plan a graded ending. [synthesis]

25. Group integration circle (people who used outside clinics)

  • Purpose / when: for people who have had psychedelic experiences elsewhere. A peer- or clinician-held space for integration and harm reduction, not facilitation. [source: Godasi 2019/2021]
  • Steps (per Godasi's PsychedeLiA-based agenda): (1) Welcome, and define integration and the group's mission. (2) Read a legal disclaimer. (3) Centering meditation. (4) Introductions and an intentions round. (5) Read the group rules aloud (at minimum confidentiality and respect). (6) Circle discussion with timed shares; gently limit dominant members. (7) Closing. Admit only sober adults, start on time, and consider closing entry shortly after the start. Keep a resource and hotline list at the welcome table. [source: Godasi 2019/2021] Add a rule against discussing sourcing or dosing. [synthesis: Godasi does not specify this]
  • Example language (illustrative): "This circle is for making sense of experiences, not for planning them. We don't discuss where to get substances or how much to take."
  • Watch for: members in crisis. Refer to professional care. A clinician running such a group still holds their professional duties, including risk assessment. [source: Godasi (referral); synthesis]

26. Harm-reduction assessment for group members using outside clinics

  • Purpose / when: when a client reports past or planned use outside regulated settings. This is harm reduction only; it never supports or arranges illegal use. [synthesis]
  • Steps: (1) Assess history, current mental state, medical conditions and medications, without judgement. (2) Give general education: risks of psychiatric destabilisation, medication interactions in general terms, and risks of unregulated group settings, including boundary violations by facilitators. (3) Safety-plan, including a sober trusted person and crisis contacts. (4) Refer to medical review where interactions are possible. (5) Offer integration support. Do not advise on substances, amounts or providers. [synthesis]
  • Example language (illustrative): "I can't help you arrange it, but I can help you think through the risks and be here afterwards."
  • Watch for: signs that a group or retreat is coercive. See the red flags in section 5. [synthesis]

27. Standing safety monitoring

  • Purpose / when: every visit (UCSF). Detects adverse events and suicidality early. [source: Anderson 2020]
  • Steps: (1) Adverse-event interview. (2) Suicide-risk screen (C-SSRS). (3) After the session, a challenging-experience measure the next day (UCSF used the Challenging Experience Questionnaire). (4) Escalate per protocol. A data safety monitor oversaw the trial. [source: Anderson 2020] In the UCSF protocol, short-lived challenging reactions on the day are expected and met with supportive reassurance. A negative psychological reaction lasting more than 24 hours counts as a serious adverse event, and a study physician follows the person until it resolves. Such a participant is not automatically withdrawn, because the group integration sessions may help recovery. Medical management stays with the on-call physician. [source: NCT02950467 protocol]
  • Example language (illustrative): "Before we start, any new physical or emotional changes since we last met? Any thoughts of not wanting to be alive?"
  • Watch for: substance relapse. UCSF recorded one methamphetamine relapse as an unexpected adverse reaction. [source: Anderson 2020 via Chacruna]

28. Therapist team debrief / process group

  • Purpose / when: after sessions and at the end of a cohort. HOPE describes a post-study therapist group process session. [source: Lewis J Psychedelic Stud 2023]
  • Steps: (1) Review each participant. (2) Review team dynamics and moments of strain. (3) Check consistency of conduct, boundaries and touch. (4) Agree protocol changes. [synthesis for steps]
  • Example language (illustrative): "Where did any of us feel pulled to act differently than we'd agreed?"
  • Watch for: facilitator variability, which Roots To Thrive names as a limitation. [source: Dames 2025]

29. Participant feedback and protocol adaptation

  • Purpose / when: after each cohort (UCSF focus groups, plus DSMB review). [source: Anderson 2020]
  • Steps: (1) Hold a structured feedback group. (2) Note requested changes. UCSF added post-session groups; HOPE participants raised music choice, eyeshades and room comfort. (3) Adapt within ethics and regulatory approval. [source: Anderson 2020; Lewis 2023]
  • Example language (illustrative): "What should we keep, and what should we change for the next group?"
  • Watch for: only the most vocal members' views being heard. Add anonymous feedback. [synthesis]

30. Culturally grounded elements and Elder involvement

  • Purpose / when: where participants and communities want it. Roots To Thrive includes Indigenous Elders or cultural guides who provide ceremonial context and grounding, and closes with a practice rooted in Indigenous teachings. [source: Dames 2025]
  • Steps: the clinician's role is to invite and support cultural leaders who hold that authority, to ask participants what they want, and to respect any element they decline. Do not lead ceremony or borrow its elements yourself. [synthesis]
  • Example language (illustrative): "Would having an Elder or cultural support person involved matter to you?"
  • Watch for: tokenism or appropriation. Make sure cultural roles are real and resourced. [synthesis]

5. Handling problems

The sources report few problem scenarios. Each item says what is sourced and what is my own guidance [synthesis].

  • A member's experience differs from the group's (social comparison, marginalisation). HOPE warns that groups can amplify suggestibility and social comparison and may marginalise people whose experiences differ. [source: Lewis J Psychedelic Stud 2023] Response [synthesis]: in preparation, normalise the full range (nothing much, hard, blissful, confusing). In integration, explicitly invite "different" experiences first. Never rank experiences. Follow up individually with anyone who goes quiet.
  • Distress spreading across the room during co-located dosing. Not addressed in the sources. [synthesis] Response: the lead therapist monitors the whole room. Dyad therapists of nearby participants briefly name what is happening ("someone is having a hard time and is being cared for"). Offer headsets or extra music volume. Use the breakout room if the distressed person agrees. Debrief in integration.
  • Intolerance of the shared music. One HOPE participant found the playlist intolerable and was supported within the group space. Some participants wanted personal choice. [source: Lewis 2023] Response: frame the playlist in preparation, and offer headsets as Roots To Thrive does. [source: Dames 2025; synthesis for combining them]
  • Discomfort with eyeshades or the room. Two HOPE participants disliked eyeshades, and a minority found the room confining. [source: Lewis 2023] Response: make eyeshades optional, allow posture changes, and offer a couch where possible. [source: Lewis 2023 suggestions]
  • Severe anxiety, paranoia or physiological changes during the session. UCSF found verbal reassurance often eased severe anxiety. For a participant with paranoia and blood-pressure elevation, the team darkened the room and adjusted the music. Medical management belongs to medical staff, and no participant needed restraint or emergency psychiatric medication. [source: Anderson 2020; HOPE likewise reported no use of private room or emergency psychiatric medication, PsyPost 2023] Response: reassure, reduce stimulation, alert medical staff immediately, and debrief afterwards.
  • Re-emergence of trauma (flashbacks) after the session. UCSF recorded a PTSD flashback. [source: Anderson 2020 via Chacruna] Response [synthesis]: offer extra individual integration, use stabilisation and grounding, and refer to trauma-focused treatment if symptoms persist. Do not process trauma detail in the full group unless the person chooses to.
  • Substance relapse. UCSF recorded a methamphetamine relapse. [source: Anderson 2020 via Chacruna] Response [synthesis]: screen for current substance use. Respond without shame, connect the person to addiction care, and agree with them what is shared in the group.
  • Shame blocking disclosure. Processing shame was hard for some UCSF members, but peer validation helped. [source: Anderson 2020] Response: pace disclosure to trust, model it from facilitators, and protect against pressure. [source: Dames 2025 (pace to trust, model vulnerability)]
  • Suicidality and hopelessness (illness and existential groups). Response: screen for suicide risk at every visit [source: Anderson 2020]. Use standard risk assessment and safety planning, including lethal-means counselling (safe storage and removal only). Meet hopelessness with a meaning-centred, life-affirming response as in SEGT. [source: Stanford SEGT page; synthesis]
  • Non-adherence to preparation (missed groups, incomplete steps). Roots To Thrive requires all preparatory components before the first medicine session. [source: Dames 2025] Response [synthesis]: explore the barrier, offer an individual catch-up, and defer the medication session to a later cohort if preparation is incomplete. Present this as safety, not punishment.
  • Dominant or advice-giving members. Response: timed shares and gentle limiting [source: Godasi]. Redirect advice into the speaker's own felt sense (compassionate witnessing) [source: Dames 2025].
  • Latecomers and changing membership. Oregon's rule requires every client to be present when a group administration session begins. Godasi suggests closing entry shortly after the start. Roots To Thrive keeps small-group membership fixed. [source: OAR 333-333-5230; Godasi; Dames 2025] Response [synthesis]: close cohorts after the first group. Handle drop-outs openly with the remaining members.
  • Wish to leave the group format. Oregon requires each client to be offered one-to-one support from a facilitator on request, and lets a client reschedule with another group or facilitator after meeting the facilitators. [source: OAR 333-333-5230 and 5020] Response: make this an easy, non-shaming option, and arrange individual care. [synthesis]
  • Ruptures with a therapist or between members. Response [synthesis]: name the rupture, take responsibility for any part you played, and repair in the dyad first, then in the group if it involved the group. Bring it to team debrief (Intervention 28).
  • Confidentiality breaches. Godasi names confidentiality as a minimum rule but gives no breach procedure. [source: Godasi] Response [synthesis]: revisit the agreements, speak privately with those involved, and tell members in advance that confidentiality between members cannot be guaranteed.
  • Romantic, sexual or financial relationships between members, or with staff. Not in the sources for members. [synthesis] Response: include in the agreements a request to disclose outside contact. Any staff–participant sexual or romantic contact is a serious boundary violation to be reported under professional and regulatory rules. HOPE cites reports of coercive and abusive behaviour in psychedelic therapy as a reason for deliberate protocol design. [source: Lewis 2023]
  • Group pressure toward particular beliefs or interpretations. HOPE flags raised suggestibility. [source: Lewis 2023] Response [synthesis]: do not interpret experiences for participants. Treat spiritual or metaphysical meanings as the person's own, without endorsing them as fact. Watch for group consensus forming around one leader's worldview.
  • Cultural mismatch. Indigenous participants in Roots To Thrive asked for relational authenticity and Indigenous team members. Mixed-gender groups are supported by facilitators of matching genders where possible. [source: Dames 2025] Response: build these into staffing. Do not appropriate ceremony (Intervention 30).
  • Therapist variability and fatigue. Roots To Thrive names facilitator variability and heavy training and resource demands. HOPE used a team of ten with brief psychedelic-therapy training. [source: Dames 2025; Lewis 2023] Response [synthesis]: use a shared protocol, supervision, debriefs and rotation, and plan back-up cover for every role on the medication day.
  • Clients from unregulated group ceremonies or retreats. Response [synthesis]: assess for adverse psychological effects and for boundary violations or coercion (pressure to keep using, to cut off family or treatment, sexual contact, financial exploitation, secrecy). Provide integration and trauma care. Support any reporting the client wants to make. Never help them arrange further use.

Sources

Web sources:

Further web sources (checked October 2026):

Further cited works:

  • Agrawal M., et al. (2024). Phase II open-label trial of psilocybin-assisted therapy with group preparation and integration in patients with cancer and major depressive disorder (NCT04593563). Cancer, doi:10.1002/cncr.35010 [uncertain: exact article title not verified]. Earlier research letter: Agrawal M., Emanuel E., Richards B., Richards W., Roddy K., Thambi P. (2023). Assessment of psilocybin therapy for patients with cancer and major depression disorder. JAMA Oncol 9(6):864–866.
  • Lewis B.R., Garland E.L., Byrne K., Durns T., Hendrick J., Beck A., Thielking P. (2023). HOPE: a pilot study of psilocybin enhanced group psychotherapy in patients with cancer. J Pain Symptom Manage.
  • Lewis B.R., Byrne K., Hendrick J. et al. (2023). Group format psychedelic-assisted therapy interventions: observations and impressions from the HOPE trial. J Psychedelic Stud 7(1), doi:10.1556/2054.2022.00222 (abstract and structured summary via Blossom).
  • Trope A., Anderson B.T., Hooker A.R., Glick G., Stauffer C., Woolley J.D. (2019). Psychedelic-assisted group therapy: a systematic review. J Psychoactive Drugs 51(2):174–188.
  • Spiegel D. & Classen C. (2000). Group Therapy for Cancer Patients: A Research-Based Handbook of Psychosocial Care. Basic Books.
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