Therapist-rated predictors of response to psychedelic-assisted therapy

Therapists viewed the quality of the therapeutic relationship as the strongest predictor of successful psychedelic-assisted therapy outcomes

In this cross-sectional survey study using expert therapist ratings researchers found that therapists viewed the quality of the therapeutic relationship as the strongest predictor of successful psychedelic-assisted therapy outcomes. Across a survey of 158 psychedelic therapists, the factors most associated with positive long-term response were a strong therapeutic alliance, good social support, openness, secure attachment, and a patient’s ability to surrender to the experience. Therapists also emphasized the importance of preparation, integration, mindset (“set”), and environmental context (“setting”). In contrast, prior non-psychedelic substance misuse was rated as the strongest predictor of poor outcomes. The study additionally found differences across treatment settings and substances: therapists working with psilocybin placed more importance on preparation and therapist presence than those working with ketamine, while clinicians in unregulated settings were more likely to view difficult or challenging experiences as therapeutically valuable. Overall, the paper suggests that psychological and relational factors may be at least as important as the psychedelic substance itself in determining therapeutic benefit

“Psychedelic-assisted therapy has shown promise in the treatment of a range of psychiatric disorders, yet therapeutic responses remain highly variable. Although prior research has focused predominantly on features of the acute psychedelic experience, less attention has been paid to baseline characteristics and preparatory factors. Moreover, therapist-derived insights from real-world practice have not yet been explored. Here we conducted a cross-sectional survey distributed to therapists involved in psychedelic-assisted therapy to assess the perceived impact of baseline, preparation and session parameters on therapeutic outcomes.

A total of 158 therapists completed the survey and rated predictors of favorable and unfavorable long-term outcomes. Therapists identified several factors as particularly conducive to positive outcomes, with the highest ratings given to a strong therapeutic alliance, robust social support, personality traits such as openness and capacity to surrender, secure attachment and a belief in an active mode of therapeutic action.

By contrast, prior use of nonpsychedelic substances was perceived as the most unfavorable predictor of therapeutic response. Differences also emerged according to therapists’ setting of practice and primary substance of experience. Therapists working in unregulated settings rated certain challenging features more favorably. Meanwhile, therapists working with psilocybin placed greater emphasis on preparation and therapeutic presence than therapists working with ketamine. The thematic analysis of open-ended responses further highlighted the importance of preparation, integration, patient mindset and environmental context. These findings provide clinically grounded insights into the key predictors of psychedelic-assisted therapy outcomes and may inform future screening protocols and the optimization of treatment protocols.”

Viljoen, G., Bendau, A., Walter, H. et al. Therapist-rated predictors of response to psychedelic-assisted therapy. Nat. Mental Health (2026). Read Paper

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