These findings highlight the importance of the therapeutic relationship in PAT. Future research should explore therapist and participant characteristics which maximize the therapeutic alliance and evaluate its relationship to treatment outcomes.

Among individuals with chronic posttraumatic stress disorder, therapeutic alliance predicted changes in posttraumatic stress disorder severity following MDMA-assisted psychotherapy. Therapeutic alliance may play a key role in facilitating therapeutic improvement within MDMA-assisted psychotherapy. Further research remains necessary to confirm these preliminary findings and the role of therapeutic alliance in MDMA-assisted psychotherapy.

In psychedelic-assisted therapy, the therapeutic container is built upon alliance, trust, safety, and support. The history of the therapeutic alliance is reviewed and applied to the work of psychedelic psychotherapy.