Switzerland limited medical use of psychedelics

1. Introduction

Version followed: the Federal Office of Public Health (FOPH/BAG) regime for "beschränkte medizinische Anwendung" (limited medical use) of prohibited narcotics as published on the BAG website (consulted October 2026; checklist dated 16 Dec 2024), with clinical procedures taken from the Oehen & Gasser (2022) group model and the Krähenmann (2024) SGPP-aligned treatment recommendations. Where these differ, both are named. [source: BAG page; Oehen & Gasser 2022; Krähenmann 2024]

What it is. This is a regulated access programme. It is not a single therapy. Under Art. 8 para. 5 of the Narcotics Act (BetmG/NarcA, SR 812.121), the BAG can grant one treating physician an exceptional, case-by-case authorisation (Ausnahmebewilligung) to use a prohibited substance (LSD, MDMA or psilocybin, all listed in Verzeichnis d of the BetmVV-EDI) for one named patient. Each authorisation covers one substance and is valid for 12 months, renewable. Other legal bases are Art. 8 BetmKV, Art. 28–29 of the Betäubungsmittelsuchtverordnung (BetmSV), and the Therapeutic Products Act (HMG). [source: BAG page; Rickli 2025; Chambers 2026]

History and scale. Between 1988 and 1993, members of the Swiss Medical Society for Psycholytic Therapy (SÄPT: Styk, Baumann, Roth) worked under earlier permits, including in groups. The current programme began in 2014 with two physicians (Gasser, Oehen) and LSD/MDMA, and psilocybin was added in 2021. In 2024 about 100 physicians held 723 patient authorisations: 348 psilocybin, 245 MDMA and 130 LSD. These covered about 1,660 treatments, delivered in roughly 80 private practices and 15 institutions, including four university hospitals. The most frequent indications in 2024 were depression, PTSD, anxiety disorders and dependence, followed by anorexia, cluster headache and OCD. [source: Gasser 2017; Liechti et al. 2025 (via Blossom summary); Rickli 2025] Liechti et al. are summarised as saying the Swiss framework for exceptional medical use dates back to 1951 [uncertain: secondary summary only].

Core idea of how change happens (as the Swiss clinicians describe it). The substance session is one part of a longer course of psychotherapy and does not replace it. Oehen & Gasser (2022) describe a trauma-focused, exposure-based model informed by structural dissociation theory. Altered states lower avoidance and speed emotional access to traumatic memories and relational patterns. Mystical-type experiences are associated with better outcomes, and the group adds peer support and intensifies the process. The real work happens in preparation and in integration, both in the group and in ongoing individual therapy. [source: Oehen & Gasser 2022]

Legal status (as of the sources' dates).

Switzerland: LSD, MDMA and psilocybin are prohibited (Verzeichnis d). Outside an authorisation, possessing, supplying or offering "guided" sessions is a criminal offence for both operators and physicians. Using these substances for therapist self-experience is described as illegal. Public advertising of the services is not allowed. No psychedelic product has Swiss marketing authorisation. Mandatory health insurance generally does not cover the substance or the session day. [source: Chambers 2026; Krähenmann 2024; Liechti et al. 2025]
Elsewhere (reported by Chambers 2026, not verified in primary texts) [uncertain]: Germany began a psilocybin compassionate-use programme in July 2025. Czech legislation took effect on 1 January 2026. A US Executive Order was issued on 18 April 2026, but its content is not described here.

2. Framework

The programme sets a legal and administrative frame. Clinicians fill it with a preparation, session and integration structure. Phases 1 and 6 below are regulatory and are run by the physician. Phases 2 to 5 are clinical.

Phase 0: Referral and indication check (any treating psychotherapist or physician)

Goal: decide whether the client plausibly meets the legal criteria and the clinical indications, then refer to an authorised or experienced physician.
Legal eligibility (all four must be met, "kumulativ"): (1) a mostly incurable illness; (2) the substance is expected to relieve the suffering; (3) existing treatments are exhausted, or none exists; (4) treatment supports a more independent life, for example by avoiding inpatient care. The patient must live in Switzerland. There is no legal right to an authorisation. [source: BAG page; Rickli 2025]
Operational treatment resistance (Oehen & Gasser 2022): for trauma disorders, at least two unsuccessful courses of psychotherapy plus a failed trial of a standard antidepressant class. For depression or anxiety, insufficient response to several antidepressants, augmentation and psychotherapy.
Indications listed by Krähenmann (2024, summer 2024 status): treatment-resistant moderate-to-severe depression without psychotic features; treatment-resistant moderate-to-severe anxiety disorders; depression or anxiety with severe, palliatively treated physical illness; treatment-resistant moderate-to-severe alcohol dependence; moderate-to-severe PTSD. The SGPP (Sept 2024) positions this treatment as an off-label third-line option. [source: Krähenmann 2024; Chambers 2026]

Phase 1: Screening, consent and application (physician)

Psychiatric and somatic screening, consent (Section 4), and a complete, hand-signed paper application to the BAG. The application includes patient and physician data, the physician's evidence of experience, medical information according to the BAG checklist, the supply pharmacy, financing, and the physician's signed undertaking to submit progress reports and report serious adverse events. Electronic, fax or e-mail applications are not accepted. A digital submission platform is planned, possibly from the end of 2026. [source: BAG page; Rickli 2025] The checklist itself is not drawn on here [uncertain: exact checklist items].
Who may apply: only the treating physician who is entitled to practise in Switzerland. Patients cannot apply. A first-time applicant must show experience, for example through further training, membership of a specialist society (SÄPT, ASPT, SSPM/swisspsychedelic, Fondazione Alaya) and exchange with experienced colleagues. Psychologist-psychotherapists cannot hold the authorisation, but they work in the team and provide preparation and integration. [source: BAG page] Chambers (2026) reports that new authorisations for psychiatric indications have reportedly been restricted to specialists in psychiatry since 2025–26 [uncertain: not stated on the BAG page].

Phase 2: Preparation (individual, sometimes followed by group)

Goals: psychoeducation, a stable alliance, emotion-regulation and safety skills, a working hypothesis linking symptoms to biography, realistic expectations, and intentions. [source: Oehen & Gasser 2022; Krähenmann 2024]
Length: variable. The Oehen & Gasser case vignette had more than a year of preparatory psychotherapy. Most patients were already in regular therapy with the authors. [source: Oehen & Gasser 2022]
Moving on: consent is signed and the authorisation is granted. The alliance can hold intense material. Fears of the experience, of speaking in a group, or of shame are worked through enough. For group entry, the person's goals fit the group (see Section 4).

Phase 3: Substance-assisted session(s)

Format: individual outpatient sessions or groups. Groups were the more common format in the outcome sample. Patients typically had two to four substance sessions within one authorisation. [source: Liechti et al. 2025] Krähenmann (2024) recommends a limited series of sessions followed by formal reassessment of the indication before any further series. He notes the evidence is weak for added benefit from repeated series and absent for maintenance use. [source: Krähenmann 2024]
Group format, three named versions:
- Gasser 2017: three-day workshop (preparatory evening, session day, integration morning); 4–8 patients; two therapists who alternate as leader. [source: Gasser 2017]
- Oehen & Gasser 2022: same three-day frame; up to 12 participants; three therapists including at least one woman. One therapist is the main guide, rotating between the two authors, and the others are co-therapists or sitters. [source: Oehen & Gasser 2022]
- Krähenmann 2024: groups of up to 4–6 patients with at least 2–3 therapists. Individual sessions need at least two staff, ideally a physician or psychologist plus a nurse. Where touch may be needed, two people of different sexes should be present. [source: Krähenmann 2024]
End of the session day: outpatients are discharged only when the effects have fully resolved, and a trusted person accompanies them home. [source: Krähenmann 2024]

Phase 4: Integration

Group integration the following morning (about four hours in the Oehen & Gasser model). [source: Oehen & Gasser 2022]
First clinical follow-up within two to three days, with phone or electronic contact in the days after. [source: Krähenmann 2024]
Ongoing individual integrative psychotherapy between sessions, with the authors or with the referring therapist. [source: Oehen & Gasser 2022]

Phase 5: Deepening (trauma model)

An early phase works on motivation, alliance and reducing ambivalence and avoidance. A later, more intensive phase starts once emotion regulation, negative self-perception and structural dissociation have improved and exposure is better tolerated. [source: Oehen & Gasser 2022]

Phase 6: Renewal, reporting and termination (physician)

An interim report is due as the BAG requires. To continue, the renewal application with a therapy report must be submitted at least two weeks before expiry. A final report is due when treatment ends. Serious adverse events must be reported to the BAG within seven working days. On-site inspections are possible. [source: BAG page]
Integrative therapy is tapered toward termination as the patient stabilises. [source: Oehen & Gasser 2022]

3. Guiding principles

Last resort, case by case. In practice: document failed standard treatments before referring, and treat the authorisation as an exception, not an entitlement. [source: BAG page]
Physician-held licence and responsibility. In practice: as a non-physician psychotherapist, you never handle or arrange substances. You contribute assessment, preparation and integration under the physician's authorisation. [source: BAG page; Chambers 2026]
Embedded in ongoing psychotherapy. In practice: no session without a continuing therapeutic relationship and an integration plan. Outside therapists must agree to an intake, to an integration session after each experience, and to communication among all treating clinicians. [source: Oehen & Gasser 2022]
Trauma-informed, phase-oriented work. In practice: follow the complex PTSD sequence of stabilisation, then processing, then reintegration, and stabilise dissociation before exposure. [source: Oehen & Gasser 2022]
Protect the inward process. In practice: eyes closed, little talk in the early hours, no interaction between participants until later. [source: Gasser 2017; Oehen & Gasser 2022]
Quiet presence, active when needed. In practice: sit silently if all is well, and give brief guidance when there is distress or avoidance. [source: Oehen & Gasser 2022]
Safety and a two-person frame. In practice: at least two staff, emergency access, mixed-sex presence where touch may occur, and medical monitoring by medical staff when clinically indicated. [source: Krähenmann 2024]
Consent covers touch. In practice: agree on touch in advance, use it only when helpful, and keep it minimal. Gasser 2017 describes "implied" consent in groups. Krähenmann 2024 asks for prior consent and avoidance where possible. Follow the stricter version [synthesis].
Informed consent needs capacity. In practice: the written, hand-signed declaration names the substance and must be redone if the substance changes. Check the client's understanding and capacity. [source: BAG page; Krähenmann 2024]
Realistic expectations. In practice: tell clients that first sessions are often hard and that trauma recall can take many sessions. [source: Oehen & Gasser 2022; Krähenmann 2024]
The group is therapeutic and needs structure. In practice: clear rules, consistent guidance, conflicts named in advance, and group behaviour read as a mirror of personal issues. [source: Oehen & Gasser 2022]
Avoidance is clinical material. In practice: leaving the room, smoking, pacing or note-taking is addressed as avoidance, not merely managed. [source: Oehen & Gasser 2022]
Watch mood closely, especially in recurrent depression. In practice: monitor during and after sessions, because relapse can be hard to tell apart from difficult processing. [source: Oehen & Gasser 2022]
Collaborative care. In practice: coordinate with every treating clinician and hand over to routine care when appropriate. [source: Krähenmann 2024; Oehen & Gasser 2022]
Documentation and reporting. In practice: keep records good enough for interim, renewal and final reports, and report serious adverse events within seven working days. [source: BAG page]
Therapist self-experience: the sources disagree [uncertain]. Oehen & Gasser expect therapists to have experienced altered states in a therapeutic setting. Krähenmann (2024) says the evidence does not support mandatory self-experience as a quality criterion and notes that self-experience use is illegal in Switzerland. In practice: do not pursue or advise illegal self-experience.

4. Intervention inventory

The programme itself prescribes no techniques. The BAG regulates who may treat, eligibility, consent and reporting. The procedures below are those published by Swiss programme clinicians: Gasser 2017 and Oehen & Gasser 2022 (group model), and Krähenmann 2024 (SGPP-aligned recommendations). Regulatory steps are included because a clinician must carry them out. Substance handling, supply and medical monitoring are the authorised physician's and medical staff's job and are not described here. All example language is illustrative.

4.1 Referral and eligibility pre-check (outside psychotherapist)

Purpose / when: before you raise the option with a client or refer to an authorised physician.
Steps:
1. List the client's prior treatments: medication classes, augmentation and psychotherapy courses, with dates and responses. This is the evidence for the "therapies exhausted" criterion. [source: BAG page; Oehen & Gasser 2022]
2. Check the four cumulative legal criteria and that the client lives in Switzerland. [source: BAG page]
3. Screen for obvious exclusions (see 4.2) so you do not raise false hopes [synthesis].
4. Find a physician through the specialist societies (SÄPT, ASPT, SSPM/swisspsychedelic, Fondazione Alaya) or a university or cantonal service. [source: BAG page; Chambers 2026]
5. Agree in writing that you will attend or provide an integration session after each experience and that all treating clinicians may share information. [source: Oehen & Gasser 2022]
6. Explain the cost and that mandatory insurance generally does not pay for the substance or the session day. [source: Liechti et al. 2025; Chambers 2026]
Example language (illustrative): "This isn't a treatment I can offer or arrange myself. A licensed doctor has to apply to the federal health office for you, and there's no guarantee it will be approved. What I can do is help gather your treatment history and keep working with you before and after."
Watch for: pressure to proceed despite no real treatment resistance; hopes of a cure; financial strain. It is working when the referral letter documents the criteria clearly and the client's expectations are realistic.

4.2 Medical and psychiatric screening (physician-led; you contribute history)

Purpose / when: before the application. The aim is an individual risk-benefit judgement. [source: Krähenmann 2024]
Steps:
1. The physician takes a full psychiatric history, including personal and first-degree family history of psychosis or bipolar disorder. [source: Oehen & Gasser 2022; Krähenmann 2024]
2. Exclusion or contraindication criteria published by Krähenmann 2024: pregnancy or breastfeeding; age under 18; personal or close family history of psychosis or bipolar disorder; severe personality disorder; dissociative disorder; dementia; severe anxiety or panic disorder; acute suicidality; epilepsy or seizure history; uncontrolled hypertension, coronary disease, or cerebral or aneurysmal vascular disease; predisposition to malignant hyperthermia; substance use disorder history (to be screened); and medications that reduce the effect or increase risk.
3. Exclusions used by Oehen & Gasser 2022: borderline personality disorder as the index diagnosis; personal or first-degree family history of psychosis or bipolar disorder; acute drug dependency (medical cannabis use was accepted); age under 20; limited capacity; no prior standard treatment; residence outside Switzerland. Comorbid borderline traits were accepted only after careful assessment of self-harm risk, suicidality, impulsivity and the stability of the alliance.
4. Somatic work-up: medical and neurological examination, laboratory tests and ECG, plus urine drug screen, brain imaging or EEG when indicated. This is a physician task. [source: Krähenmann 2024]
5. The physician reviews medications, and any psychotropic adjustment is made case by case, well before sessions. You do not advise clients on medication changes. [source: Oehen & Gasser 2022; Krähenmann 2024]
Example language (illustrative): "The doctor will ask about your family's mental health history and run some medical checks. These questions are about safety. They aren't a judgement of you."
Watch for: the two versions differ on dissociative disorders. Krähenmann lists dissociative disorder as an exclusion, while Oehen & Gasser treated many patients with dissociative disorders and complex PTSD. Which applies depends on the treating physician's protocol [uncertain]. Also watch for clients concealing history in order to qualify.

4.3 Informed consent

Purpose / when: a legal requirement before the application. Clinically, it continues throughout treatment.
Steps:
1. The patient signs a written declaration by hand, with full name and date, naming the specific substance. A new declaration is needed if the substance changes. [source: BAG page]
2. Cover the unapproved, experimental status; expected effects; risks (Section 5); behavioural rules; touch; the possibility of difficult experiences; costs; and data reporting to the BAG and the voluntary registry. [source: Krähenmann 2024; Liechti et al. 2025]
3. Confirm decision-making capacity. [source: Krähenmann 2024]
4. Ask the client to repeat back the key risks and the rules [synthesis].
Example language (illustrative): "Tell me in your own words what could go wrong on the day and afterwards, and what you'd do if it did."
Watch for: consent given under desperation or idealisation. Check again before each session [synthesis].

4.4 Psychoeducation

Purpose / when: throughout preparation, and before the first session in particular.
Steps: explain how states of consciousness typically unfold; how trauma responses and memories may surface; risks and benefits; what the therapists and sitters will and will not do; the rules; and realistic expectations. [source: Oehen & Gasser 2022; Krähenmann 2024]
Example language (illustrative): "Early sessions often start pleasantly and then bring up painful material. That isn't a sign it's failing. We'll be there, and the next day we'll make sense of it together."
Watch for: fixed beliefs about mystical breakthroughs. The client can say what to do when frightened.

4.5 Alliance building and the working hypothesis

Purpose / when: before any session. The relationship has to be stable enough to hold highly charged material. [source: Oehen & Gasser 2022]
Steps:
1. Continue regular psychotherapy; this may take months, or more than a year in complex cases. [source: Oehen & Gasser 2022]
2. Develop and share a working hypothesis connecting current symptoms to biography and trauma history. [source: Oehen & Gasser 2022]
3. Explore the client's fears of the experience, of the therapists and of the group. [source: Oehen & Gasser 2022]
Example language (illustrative): "Our working idea is that the numbness protects you from what happened when you were young. If that comes closer in a session, we'll take it at the pace you can manage."
Watch for: idealising transference toward the guiding therapist. It is working when the client can disagree with you and report shame.

4.6 Regulation and safety skills training

Purpose / when: preparation, especially for trauma and dissociation.
Steps: teach emotional awareness and regulation, self-soothing, breathing techniques and personal-safety strategies, and practise them in session until the client can use them independently. Krähenmann adds rehearsal exercises such as guided imagery or a body scan. [source: Oehen & Gasser 2022; Krähenmann 2024]
Example language (illustrative): "Let's practise now: feel your back against the chair, breathe out slowly, and name three things you notice in your body."
Watch for: skills that only work with you present. Check whether the client uses them at home [synthesis].

4.7 Choosing individual versus group start

Purpose / when: at the end of preparation.
Steps: Oehen & Gasser start with individual preparation or individual sessions when there is: strong fear of the experience itself; fear of speaking in front of strangers; prominent shame, especially after sexual trauma; end-of-life concerns; cluster headache; or autism spectrum disorder. Otherwise patients may join the group directly. Group members should have compatible goals. Mixing short-term symptom-relief seekers with people doing long-term trauma work produced unstable alliances. [source: Oehen & Gasser 2022]
Example language (illustrative): "Given how hard it is for you to talk about what happened, I suggest we begin one-to-one and think about the group later."
Watch for: a client pushing for the group to avoid intimacy with one therapist, or the reverse [synthesis].

4.8 Intention setting

Purpose / when: in individual preparation and on the preparatory evening.
Steps: each participant states their concerns and intentions for the next day in the group round. Intentions are tied to the working hypothesis. [source: Gasser 2017; Oehen & Gasser 2022]
Example language (illustrative): "What would you like to turn toward tomorrow, and what are you most afraid of meeting?"
Watch for: rigid goals. Encourage openness to whatever comes [synthesis].

4.9 Preparatory evening (group, Day 0)

Purpose / when: the evening before the session day. It lowers anxiety, orients new members and sets intentions.
Steps:
1. Warm-up with breath or body-awareness exercises. [source: Gasser 2017; Oehen & Gasser 2022]
2. Introduce new members. Each person reports recent developments, concerns and fears. [source: Oehen & Gasser 2022]
3. Name any conflicts between members now, so each person can work on their own part during the session or on the integration day. [source: Oehen & Gasser 2022]
4. Answer questions about how the day will run. Teach how to handle altered states and difficult emotions or memories. [source: Gasser 2017; Oehen & Gasser 2022]
5. Participants choose their place in the room. The evening closes with music, and participants stay overnight locally. [source: Oehen & Gasser 2022] Gasser 2017 gives about three hours for this evening.
Example language (illustrative): "If something frightening comes tomorrow, try to stay with it and breathe. You can signal us at any time, and one of us will come and sit with you."
Watch for: unspoken tension between members, or a newcomer overwhelmed by others' stories.

4.10 Group agreements

Purpose / when: agreed in preparation and restated on the preparatory evening.
Steps: participants agree to stay in the group room (two side rooms are available for retreat), not to go outside to smoke, and to keep snack and toilet trips to a minimum. Disruptive chatter is treated as a group matter. Each person agrees to write a report and complete questionnaires after the session. [source: Oehen & Gasser 2022] The Jungaberle (2008) chapter on rules and standards in substance-assisted psychotherapy, which lists further rules, is not drawn on here [uncertain]. Agreements on confidentiality, no sexual contact, no violence and no leaving the premises unaccompanied are standard safeguards [synthesis].
Example language (illustrative): "We stay together in this room for the whole day. If you need a break, a side room is there, and one of us will go with you."
Watch for: repeated rule-testing, which is usually avoidance (see 4.16).

4.11 Opening of the session day

Purpose / when: the morning of the session, before the substance is given by the authorised physician.
Steps:
1. Reconvene. Deal with last-minute concerns and invite brief contributions, such as dreams from the night. [source: Oehen & Gasser 2022]
2. Do a short body-awareness exercise to reduce initial anxiety. [source: Oehen & Gasser 2022]
3. Participants settle on their mattresses, which are arranged in a circle. Armchairs are available for people with mobility needs, and personal objects are placed in the centre. [source: Oehen & Gasser 2022]
4. Encourage eyes closed and attention turned inward. Eyeshades are offered on request. Ask participants not to interact directly during the early hours. [source: Oehen & Gasser 2022]
Example language (illustrative): "Let your attention turn inward now. You don't need to talk to anyone. Whatever comes, let it come."
Watch for: high anticipatory anxiety. Offer to sit beside the person.

4.12 Music and silence

Purpose / when: throughout the session day. Music is used to evoke, calm, activate or confront, and silence is used both to confront and to accompany peak states. [source: Oehen & Gasser 2022]
Steps:
1. The leading therapist alternates music and silence, roughly one-third music and two-thirds silence. [source: Gasser 2017; Oehen & Gasser 2022]
2. Choose music to fit the phase of the experience and the group's mood. It is usually unfamiliar to participants, and it is played through speakers so it is shared. Live instruments and pieces chosen by participants are used occasionally. [source: Oehen & Gasser 2022]
3. Watch how individuals respond and adjust.
4. Give participants a list or recording of the tracks afterwards to support regulation and integration. [source: Oehen & Gasser 2022]
Example language (illustrative): "We'll have a stretch of silence now. Stay with what is there."
Watch for: one person's distress triggered by a piece that suits the rest of the group. Respond with individual attention rather than by changing the music for everyone [synthesis].

4.13 Quiet accompaniment (sitting)

Purpose / when: the default stance during the session.
Steps: therapists move around the room and sit with participants, either spontaneously or when asked. They avoid long conversations and sit quietly when all is well. Therapists check in with each person individually. [source: Gasser 2017; Oehen & Gasser 2022] Reassuring conversation happens mainly toward the end. [source: Krähenmann 2024]
Example language (illustrative): "I'm here." (then silence)
Watch for: your own urge to interpret. Save content work for integration [synthesis].

4.14 Brief verbal guidance during distress

Purpose / when: anxiety, grief, anger or confusion during the session.
Steps: offer short verbal guidance to help the person manage the state, then redirect attention back to their process. Use body-focused instructions, such as breathing into a tense area. The aim is tolerance, not escape. [source: Gasser 2017; Oehen & Gasser 2022]
Example language (illustrative): "Breathe into where it hurts. You're safe here. Let the feeling move through."
Watch for: escalation despite guidance. Involve the physician (see Section 5). It is working when the person settles and turns back inward.

4.15 Consensual touch

Purpose / when: to help a person overcome avoidance or to give grounding, used only where appropriate. [source: Oehen & Gasser 2022]
Steps:
1. Agree on touch in preparation, covering which kinds and where. Krähenmann 2024 asks for prior consent and for touch to be avoided where possible. [source: Krähenmann 2024]
2. Forms described: holding hands, or a hand placed on a tense area. [source: Oehen & Gasser 2022]
3. In individual sessions where touch may be needed, two staff of different sexes are present. [source: Krähenmann 2024]
4. Ask again in the moment, accept a "no" at once, and document each use [synthesis].
Example language (illustrative): "Would it help if I put my hand on your shoulder?"
Watch for: sexual-trauma survivors, for whom touch can trigger re-enactment. Gasser 2017 relies on "implied" consent, which is a weaker standard. Follow the stricter version [synthesis].

4.16 Working with avoidance

Purpose / when: when a participant leaves the room, smokes, paces or takes notes during the session.
Steps: recognise the behaviour as avoidance and address it therapeutically, by gently naming it and inviting the person back to the inner process. Explore it again at integration. [source: Oehen & Gasser 2022]
Example language (illustrative): "I notice you keep wanting to get up. What happens if you lie down again for a moment and stay with it?"
Watch for: forcing the person. If distress is extreme, prioritise regulation (4.17).

4.17 Dissociation and non-epileptic seizures

Purpose / when: dissociative states or non-epileptic attacks activated during sessions.
Steps: prioritise reorientation and help the person tolerate the underlying distress before trauma work continues. In the next phase, stabilise dissociative parts before exposure. [source: Oehen & Gasser 2022] Use grounding methods from preparation (4.6). Any medical evaluation of seizure-like events is the physician's responsibility [synthesis].
Example language (illustrative): "Feel the mattress under you. You're in the group room, it's today, and I'm sitting next to you."
Watch for: repeated dissociation. This may mean the client needs more stabilisation or individual sessions.

4.18 Late-session sharing, closure and discharge

Purpose / when: at the end of the session day.
Steps:
1. Six to seven hours in, the group gathers for a brief sharing round, which helps people who are stuck or distressed to reorient. [source: Oehen & Gasser 2022]
2. Serve a light shared meal. [source: Gasser 2017; Oehen & Gasser 2022]
3. Close in the evening. Participants may stay together or leave with the therapists' help. [source: Oehen & Gasser 2022]
4. Outpatients are discharged only when effects have fully resolved, accompanied by a trusted person. [source: Krähenmann 2024]
Example language (illustrative): "Just a few words each: where are you now?"
Watch for: a person who is still confused or very distressed. Do not discharge them; involve the physician.

4.19 Integration day (group, the next morning)

Purpose / when: the morning after. Gasser and Oehen treat this as the most important part of the process, because participants are still open and less defended. [source: Oehen & Gasser 2022]
Steps:
1. Open with a piece of music from the previous day. [source: Oehen & Gasser 2022]
2. Each person describes their experience in detail, putting it into words and making sense of it. [source: Gasser 2017; Oehen & Gasser 2022]
3. Use feedback and compassion from the group to deepen understanding. Participants learn from others who met similar difficulties. [source: Gasser 2017; Oehen & Gasser 2022]
4. Link the material to the working hypothesis and to any group conflicts named on Day 0 [synthesis, building on Oehen & Gasser 2022].
5. Close (after about four hours) with instructions for handling crises, sudden trauma recall or confusing thoughts in the coming days. End with music and tidying the room together. [source: Oehen & Gasser 2022]
Example language (illustrative): "Take us through it from the beginning. What stayed with you most? And what do you make of it today?"
Watch for: participants who say little, or who move too quickly to grand interpretations. Schedule individual follow-up for them.

4.20 Crisis plan for the days after

Purpose / when: given at the end of integration day and reviewed in individual therapy.
Steps: set out who to contact and how, what to do with sudden memories, nightmares or confusing thoughts, and when to seek urgent care. Therapists keep defined procedures for crises during and after sessions. [source: Oehen & Gasser 2022] Writing the plan down and sharing it with the referring therapist is recommended [synthesis].
Example language (illustrative): "If a memory floods you at night, use the grounding steps first. If you're still overwhelmed, call this number. Someone will answer."
Watch for: clients without social support at home. Arrange extra check-ins for them.

4.21 Written report and questionnaires

Purpose / when: after each session. They support integration and outcome tracking.
Steps: the participant writes an account of the experience and completes standardised questionnaires, and both are discussed in individual therapy. [source: Oehen & Gasser 2022] Outcome questionnaires feed the voluntary registry (University Hospital Basel with IG-PAT) and the FOPH reporting. [source: Liechti et al. 2025; Chambers 2026] Licensed instruments are not reproduced here.
Example language (illustrative): "Write it down while it's fresh, even fragments. We'll read it together next week."
Watch for: reports that contradict what the client says in sessions. Explore the gap.

4.22 Follow-up and ongoing integrative psychotherapy

Purpose / when: between sessions, until termination.
Steps:
1. First clinical follow-up within two to three days, with phone or electronic contact on the following days. [source: Krähenmann 2024]
2. Regular individual integrative therapy for every participant. [source: Oehen & Gasser 2022]
3. A mid-week contact for people having a turbulent integration phase. Extra individual sessions during intense phases or for specific themes, such as fear of closeness. [source: Oehen & Gasser 2022]
4. Early detection and treatment of side effects or deterioration, in coordination with the physician, including symptomatic medication by the physician where needed. [source: Krähenmann 2024]
Example language (illustrative): "How have the last few days been, sleep, mood, memories? Anything that worried you?"
Watch for: nightmares, emotional instability and depressive relapse, especially early in treatment. [source: Oehen & Gasser 2022]

4.23 Phase-steering in trauma work

Purpose / when: across a series of sessions.
Steps:
1. Early sessions: trust and reducing avoidance. [source: Oehen & Gasser 2022]
2. Later sessions: deeper memories, shame and guilt, cognitive processing, and building a coherent trauma narrative. Recall often begins with sensations in the affected body area, and body awareness helps the client tolerate them. [source: Oehen & Gasser 2022]
3. If the client "loops", returning to the same memories over sessions without further benefit, guide the focus toward present-day life and the after-effects of trauma. [source: Oehen & Gasser 2022]
4. Expect complex PTSD to need more sessions than single-event PTSD. [source: Oehen & Gasser 2022]
Example language (illustrative): "We've been back to that night several times. This time, could you turn toward how it shapes your life now, with your partner and at work?"
Watch for: retraumatisation without new understanding. In that case, slow down and stabilise again.

4.24 Relational and group-dynamic work

Purpose / when: once trauma processing is under way, attachment and relational patterns become the second focus. [source: Oehen & Gasser 2022]
Steps: treat conflicts re-enacted in the group as material for integration. Allow experienced core members to take supportive, co-therapeutic roles with newcomers. Use the group as a place to practise relating differently. [source: Oehen & Gasser 2022]
Example language (illustrative): "You felt overlooked by the group yesterday. When else in your life have you felt that?"
Watch for: friendships outside the group that blur boundaries or form subgroups. Discuss these in the group [synthesis].

4.25 Regulatory reporting (physician; you supply clinical content)

Purpose / when: throughout the authorisation.
Steps: report serious adverse events to the BAG within seven working days ("innerhalb von 7 Werktagen"). Submit an interim report as the BAG requires. Submit the renewal application with a therapy report and updated medical information at least two weeks before expiry. Submit a final report at the end of treatment. The BAG can inspect the practice. [source: BAG page] SGPP-aligned recommendations also call for mandatory reporting of adverse drug reactions and high documentation standards. [source: Krähenmann 2024]
Example language (illustrative): (to the physician) "Since the last session she has had two episodes of self-harm. I think this needs to go into the report, and we should consider whether it counts as serious."
Watch for: late renewals, which interrupt treatment.

4.26 Reassessment and termination

Purpose / when: after each limited series of sessions and when the client is stable.
Steps: reassess the indication after a limited series [source: Krähenmann 2024]. Gradually reduce integrative therapy as the client stabilises, and transfer them to routine care. [source: Oehen & Gasser 2022; Krähenmann 2024]
Example language (illustrative): "You've changed a lot this year. Let's look at whether more sessions would add anything, or whether it's time to consolidate."
Watch for: dependence on the group or on the sessions. Krähenmann notes psychological dependence is more common with MDMA. [source: Krähenmann 2024]

4.27 Supporting clients who use psychedelics outside the programme [synthesis]

Purpose / when: a client tells you about illegal use, retreats abroad or underground sessions, or is considering them.
Steps: (all synthesis, framed as harm reduction)
1. Assess without judgement: what was used and in what context, why, any psychiatric history, current medications, and any adverse aftermath.
2. Explain in general terms the risks the Swiss sources name: psychosis or mania in vulnerable people, cardiovascular strain, seizures, dangerous medication interactions, persisting perceptual disturbances, and psychological dependence. Also explain the legal risk in Switzerland. [source for risks: Krähenmann 2024; legal: Chambers 2026]
3. Do not facilitate, recommend providers, or advise on substances or medication changes. Point out that the legal route exists and refer to an authorised physician if the client may be eligible.
4. Offer integration support for experiences the client has already had, and safety-plan for deterioration.
Example language (illustrative): "I can't help you arrange that, but I can help you think through the risks, and I'm here to talk about whatever comes up afterwards."
Watch for: new psychotic or manic symptoms, or suicidality, after use. Treat these as urgent and refer for psychiatric assessment.

5. Handling problems

Reported adverse effects (for orientation).

Swiss programme feedback (small sample): headache, nausea, palpitations, sleep disturbance, anxiety, psychological destabilisation and flashbacks. Suicidal thoughts were uncommon. [source: Liechti et al. 2025]
Oehen & Gasser 2022: no serious adverse events requiring hospitalisation. One prolonged delusional episode tied to a painful memory resolved with integrative work and short-term medical support. Some patients had overwhelming experiences. One patient dropped out after an unresolved transference conflict. Occasional suicidal thoughts or mild self-harm occurred, with no suicide attempts. Two patients reported unpleasant numbness or detachment.
Krähenmann 2024 (literature-based estimates): anxiety or paranoia in about 20–30% of cases; mood changes in 5–15%; acute psychosis in under 1% of people without a psychosis history; persisting perceptual disturbance in under 5%, mainly after heavy non-therapeutic use; cardiovascular effects; a lowered seizure threshold and hyperthermia risk, mainly with MDMA. Long-term effects are poorly studied.
Acute overwhelm or panic during a session. Give brief verbal guidance and grounding, offer touch if agreed, and use body-focused instructions (4.14, 4.15). The side room is available with a therapist present. If the person does not settle, the physician decides on medical measures. [source: Oehen & Gasser 2022; Krähenmann 2024] Never leave a distressed participant alone [synthesis].
Dissociation or non-epileptic attacks. Reorient first, then work on tolerating the underlying distress. Add stabilisation phases or individual sessions before further exposure. [source: Oehen & Gasser 2022] The physician rules out a medical cause for any seizure-like event [synthesis].
Stuck or looping on the same memories. Shift the focus to present-day life and the after-effects of trauma (4.23). [source: Oehen & Gasser 2022] Also review whether the working hypothesis still fits, and whether more sessions are justified at the next reassessment [synthesis].
No mystical-type experience or little apparent effect. Normalise this. Oehen & Gasser saw patients with greater needs reach such experiences only later, and some improved substantially without them. [source: Oehen & Gasser 2022] Do not escalate demands on the client or promise breakthroughs [synthesis].
Resistance and avoidance. Treat leaving the room, smoking, pacing and note-taking as avoidance and work with it therapeutically (4.16). Address the client's ambivalence in the early motivational phase. [source: Oehen & Gasser 2022]
Post-session destabilisation, nightmares or depressive relapse. This is common early in treatment. Use the early follow-up (within two to three days), mid-week contacts and extra individual sessions. The physician gives symptomatic treatment if needed. In recurrent depression, monitor mood closely, because relapse is hard to tell apart from difficult processing. [source: Oehen & Gasser 2022; Krähenmann 2024] If depressive relapse persists, involve the physician in reconsidering the indication [synthesis].
Suicidal thoughts or self-harm after sessions. Oehen & Gasser handled these within routine integrative care. [source: Oehen & Gasser 2022] Do a structured risk assessment at each follow-up, review the safety plan, involve supportive others, and counsel on lethal means (safe storage or removal). Arrange urgent psychiatric assessment for acute risk. Ask the physician whether the event is a reportable serious adverse event. [synthesis] Acute suicidality is a contraindication to further sessions. [source: Krähenmann 2024]
Psychotic or delusional symptoms. Arrange urgent physician assessment and short-term medical support, and work through the triggering material in integration. [source: Oehen & Gasser 2022] Suspend further sessions pending reassessment [synthesis].
Ruptures and transference conflicts. Unresolved transference toward the guiding therapist led to one dropout. [source: Oehen & Gasser 2022] Raise relational tension early in individual therapy, use the second therapist or co-therapist as a neutral contact, and name group conflicts before the session (4.9). [synthesis, building on Oehen & Gasser 2022]
Non-adherence. Examples: skipping integration sessions, not writing reports, breaking group rules, or an outside therapist who does not communicate. Attending integration and communication among clinicians are participation conditions in the Oehen & Gasser model. [source: Oehen & Gasser 2022] Restate these conditions, explore what lies behind the behaviour, and pause further sessions until the conditions are met [synthesis].
Group-specific problems. Divergent goals, with symptom-relief seekers mixed with people doing long-term trauma work, lead to unstable alliances, so compose groups carefully. Chatter is treated as a group issue. Shame or fear of exposure is a reason to move the person to individual work. Participants with borderline traits have more intense sessions and need extra support. [source: Oehen & Gasser 2022]
Touch and boundary concerns. Use only touch that has been agreed beforehand, keep mixed-sex staff present in individual sessions where touch may be needed, document each use, and debrief it. [source: Krähenmann 2024] If a client reports a boundary violation, take it seriously, document it, inform the authorised physician, and consider the professional and cantonal reporting routes [synthesis]. Altered states increase suggestibility and dependency on the therapist, so power imbalances are greater than in ordinary therapy [synthesis].
Somatic events (for example severe headache or cardiovascular symptoms). These are the physician's responsibility. Oehen & Gasser describe a severe headache treated medically during a session. [source: Oehen & Gasser 2022; Krähenmann 2024]
Authorisation refused, delayed or interrupted. There is no legal right to an authorisation. Incomplete applications are not processed, and late renewals interrupt treatment. [source: BAG page] Help the client grieve the disappointment, continue evidence-based treatment, and prevent impulsive turning to illegal sources [synthesis].
Cost barriers. Patients pay most costs themselves. [source: Liechti et al. 2025; Chambers 2026] Discuss the financial strain openly. Some preparation and integration psychotherapy may be billable under the 2022 psychotherapy referral model. [source: Chambers 2026; uncertain: check with the insurer]
Seeking more sessions or psychological dependence. There is no evidence for maintenance use. Reassess the indication after each series and focus therapy on consolidation. [source: Krähenmann 2024]
Client harmed in an unregulated setting (retreat, underground guide). Assess for trauma, psychotic or affective sequelae and persisting perceptual symptoms. Offer integration and evidence-based treatment, and support the client if they wish to make a complaint. [synthesis]
Outside clinician uncertain of their role. You do not prescribe or handle substances, and you do not attend sessions unless you are part of the authorised team. Your role is preparation, integration, communication and risk monitoring. [synthesis, consistent with BAG page and Oehen & Gasser 2022]

Sources

Sources:

Further reading (not drawn on) [uncertain]: the BAG Checkliste Erstgesuch PDF; the PMC full text of Liechti et al. 2025; a model training curriculum paper (PubMed 40492498); BMC Medical Education 2025 article s12909-025-06871-y; Jungaberle (2008) Regeln und Standards in der Substanz-unterstützten Psychotherapie (ResearchGate abstract only). Details of the SÄPT training programme (three-year course, 24 places per intake, 2023–2028 cycle) come only from secondary summaries. The SGPP September 2024 recommendations and the Krähenmann et al. 2023 SGPP position paper in the Schweizerische Ärztezeitung were known only through the Krähenmann slides and Chambers.

Books cited: Jungaberle H., Gasser P., Weinhold J., Verres R. (eds.) (2008) Therapie mit psychoaktiven Substanzen. Bern: Huber (not drawn on).

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