MDMA THERAPY

Discussions about psychedelic therapy often focus on the substance itself: psilocybin, MDMA, or another substance that can alter consciousness and emotions. However, both scientific research and practical experience are showing increasingly clearly that the outcome is determined not only by what someone ingests, but also by who provides the guidance, how that guidance is structured, and what training a facilitator has received.

A recent study, published in BMC Medical Education, This is interesting because it does not primarily focus on the effectiveness of psilocybin, but on something that is often less visible: the training of facilitators in a clinical trial. This provides a useful framework for taking a broader view of the importance of training, professionalism, and safety within psychedelic therapy. In this context, it is important to distinguish between what we know from research, what people experience in sessions, and what practical harm reduction can contribute.

What do we mean by 'guidance' in psychedelic therapy?

Guidance in psychedelic therapy is usually more than “being present” during an intense experience. In many protocols, the process consists of three components: preparation, the session itself, and integration. The goal of this is not to force one specific outcome, but to allow the experience to unfold as safely and meaningfully as possible, within clear boundaries.

In scientific studies, guidance is often strictly protocolled. There are intake procedures, exclusion criteria, fixed contact times, and reporting. In more practice-oriented settings, similar elements are sometimes used, but the degree of standardization and supervision varies by provider. This is precisely why training facilitators is relevant: it helps to make the quality of support more consistent and to better recognize risks.

What exactly did this study investigate?

The publication written about on Trip-Forum describes a training program for facilitators within the CAPSI project in Sweden. This is a randomized, double-blind study into psilocybin for depression in the context of cancer. Important detail: the training study is therefore not about “how well psilocybin works,” but about how facilitators are prepared for their role in such a program.

The training lasted 15 weeks and was aimed at nine nurses. The program consisted of online webinars (theory and communication) and a three-day in-person workshop with role-playing and practical exercises. Afterwards, evaluation was conducted in two ways: via self-reporting (how prepared do participants feel?) and via an objective measurement of conversational skills in standardized role-plays with an actor, assessed using a well-known coding system (MITI, from the motivational interviewing field).

For those who wish to read the article themselves: the source description can be found here in the Trip-Forum article. New study on psilocybin and guidance: how important is the role of the facilitator?.

What stood out in the results?

The outcomes are nuanced and perhaps precisely for that reason instructive. The nurses felt that they had gained more knowledge and skills through the training, but they did not yet feel truly “finished” afterwards. The strongest signal was their desire for more in-person, practical training. Online education was useful for knowledge transfer, but was perceived as less suitable for developing the relational skills required in a session.

The objective measurements showed only limited improvements. One global score (Partnership) improved statistically significantly; empathy increased but did not reach significance in this small group. Regarding concrete behavioral measures, there were primarily medium effect sizes, but no firm conclusions. This could have several causes: the sample size was small (n=9), there was no control group, and measurements were taken in a role-playing context rather than real sessions. It is also plausible that skills develop later, for example through supervision during actual work, something that was not yet included in the measurement.

Why training can be so decisive (without explaining everything)

A psychedelic session is not only an “intervention” but also a relational situation. A person may feel vulnerable, emotions can shift rapidly, and the process of assigning meaning can be intense. In that context, basic guidance skills make a difference: active listening, maintaining boundaries, remaining calm during tension, and being able to tolerate someone moving through a difficult phase without immediately steering or rescuing them.

That does not mean that training automatically leads to better outcomes. In fact, the study shows that training in a limited form does not immediately yield strong, measurable changes. However, the reverse is also relevant: if training is lacking or too superficial, there is a greater chance of miscommunication, awkward interventions, or missing signals of overload. In harm reduction terms, this is not about “guaranteeing success,” but about reducing risks and increasing quality.

The 'human factor': set, setting and the role of the facilitator

In research into psychedelics, there is often talk of set (mental state, expectations, intention) and setting (environment, music, social context). Guidance touches upon both. A facilitator helps someone form realistic expectations, normalize tension, and structure the environment so that it feels predictable and safe.

At the same time, it is important not to project too much onto the facilitator. A guide is not a “director” who can steer the experience to a desired endpoint. In many modern approaches, the core is precisely: supporting without forcing. This requires training, but also a professional attitude in which uncertainty and not knowing are allowed to exist.

Why background matters: nurse, therapist, coach

A striking point from the study is the tension between a medical communication style and a more psychotherapeutic style. Nurses are often trained to provide clear information, act quickly, and offer solutions. This is valuable in healthcare, but during psychedelic therapy, an overly informative or solution-oriented reflex can sometimes clash with what the situation calls for: slowing down, reflecting, emphasizing autonomy, and allowing space for inner experience.

This does not mean that one professional group is “better” than the other. It does suggest, however, that training in differentiation can be beneficial. Someone with extensive experience in talk therapy might require less basic training in reflective listening, but perhaps more in working with altered states, music, non-verbal support, or crisis protocols. Conversely, a healthcare professional might be strong in somatic signals, safety, and practical organization, but require more practice in the therapeutic conversation.

What does this say about quality and safety in practice?

This study originates from a controlled research context with protocols, selection criteria, and monitoring. In practice, this structure is not always present to the same extent. Therefore, it is advisable to ask providers or supervisors follow-up questions regarding points that indirectly reveal something about training and quality assurance, such as: is preparation and integration used, is there supervision, how are difficult experiences handled, and is there a clear approach regarding boundaries and aftercare?

The distinction between scientific research and practical contexts is also important. In the Netherlands, MDMA sessions can currently only be discussed and approached within scientific research or in practice via harm reduction. In a harm reduction context, the focus is not on providing medical treatment or making cure claims, but on guiding people who are considering this step as safely as possible, with attention to preparation, setting, risk factors, and integration.

Harm reduction: training as part of risk reduction

Harm reduction within psychedelic therapy revolves around pragmatic questions: how do you minimize the risk of overload, panic, boundary violations, or a difficult aftermath? Training of facilitators is one building block in this process, alongside screening, clear agreements, a safe setting, and the provision of realistic information.

The study underscores a practical point: skills are not learned solely from theory. Role-playing, feedback, peer supervision, and professional supervision are ways to practice behavior before it really matters. Especially in situations where someone is emotionally vulnerable, the difference between “knowing what you should do” and “actually being able to do it” can be significant.

What you can and cannot deduce from this study

It is tempting to use a study like this as proof that “guidance is all-determining” or, conversely, that “training makes little difference”. Both conclusions go too far. What we can reasonably say, however, is that this first systematic evaluation shows that (1) facilitators themselves have a clear need for more practical training, (2) measurable improvement in specific relational skills is not a given after a relatively short program, and (3) further development likely requires more practice and supervision, and possibly training that better aligns with the participant's background.

It also remains uncertain to what extent the skills measured in telephone role-plays correspond one-to-one with behavior in actual dosing sessions. This is a limitation that the authors themselves acknowledge. This nuance is important when discussing “quality” in psychedelic therapy: it can be made measurable, but can never be fully captured in a single instrument.

Conclusion

The study from April 2026 highlights an important point: psychedelic therapy is not just about pharmacology, but also about relationship, context, and craftsmanship. Training facilitators appears to be not a luxury, but a prerequisite for consistent quality and a meticulous process, especially as the field grows and various professional groups enter. At the same time, the research shows that good guidance is not achieved through theory alone, but through practice, feedback, and supervision.

If you want to read more about how guided sessions are approached in practice and what steps are often part of a process, you can also take a look at sign up for an MDMA session. It remains the case that MDMA sessions can currently only take place within scientific research or in practice via harm reduction, and that information regarding this is intended for education and safety, not as individual medical advice.