Patient-therapist relationship in psychedelic-assisted therapy: Implications for future real-world settings

The view that the use of serotonergic psychedelics in mental health care should always be psychotherapeutically embedded has recently been questioned. One argument against this model concerns the high costs it entails, which could limit the accessibility of psychedelic-assisted therapy (PAT)-a concern likely to gain traction if PAT is officially approved in the future. This paper analyzes the implications of a reductionist approach that primarily frames PAT as a pharmacological intervention, focusing on a key component of the treatment: the patient-therapist relationship. It first reviews evidence highlighting the therapeutic and ethical significance of this relationship in PAT. It then argues that shortening the preparation phase is a probable cost-saving measure that risks undermining the development of a strong patient-therapist relationship. Finally, the paper outlines three strategies to strengthen this relationship even in real-world PAT settings under cost pressure: retaining some relational elements during preparation, maintaining continuity by involving the same therapist throughout all phases, and, where possible, integrating the patient's regular therapist into the process.