Epistemic Risk Reduction in Psychedelic-Assisted Psychotherapy

Belief change is crucial to therapeutic benefit in psychedelic-assisted therapy as well as in more traditional forms of therapy. However, the use of psychedelics comes with a few unique challenges that urge extra caution. First, drastic belief changes may occur faster than in regular therapy. Facing radical and transformative insights all at once rather than through a gradual process of discovery and integration can lead patients to a volatile, confusing or disorienting epistemic state. Additionally, we know psychedelic substances to generate hallucinatory experiences that come with a high degree of confidence and noetic certainty despite not necessarily being connected with reality. On the other hand, telling a patient which ones of her beliefs are true and which ones are not seems beyond the competence of a psychotherapist, if not an abuse of their authority and power. This is even more dangerous when psychedelics are involved, because power imbalance between patient and therapist is exacerbated by the therapist’s role as a guiding figure throughout an intense altered state of consciousness. Because of this suggestible state, the therapist’s beliefs might have a disproportionate influence, and even well-intentioned nudging might significantly stray the patient’s beliefs. How can a therapist help a patient navigate their epistemic uncertainty around psychedelic insights while preserving the patient’s autonomy? In this chapter, we will review different strategies to mitigate epistemic risks in psychedelic-assisted therapy, and argue that such harm can be significantly reduced.