Client requests touch during a psychedelic session despite specifying no-touch clause within consent agreement

Richard, a 56 year old African-American, and Lauren, a 36 year old Chinese-American psychedelic guide,  have met numerous times and feel ready for a psychedelic session together. Richard and Lauren have made a “no touch” consent agreement per Richards’ request. Richard lets Lauren know the “no touch” clause is especially important to him given the physical abuse he experienced during his childhood by his mother. During the session, the topic of Richards’ abuse emerges, and he describes feeling afraid as memories flood him, and he is crying. Richard starts to shift his body towards Lauren, reaching for her, and says, “ I’m scared, can I lay my head on your lap? My big sister used to help me like that.”

Ethical Themes: Consent around touch, trauma-informed care, power dynamics, patient safety, competing values and preferences of a client during vs. before & after their psychedelics session

Specific tension: During a psychedelic session, is it ethically permissible to violate a “no-touch” clause within a signed informed consent agreement?

1. How should the guide respond to the client in this raw and vulnerable state? 

2. How might guides structure preparation sessions to prepare for such a scenario? 

3. During a psychedelic session, is it ever ethically permissible to act counter to clauses within a signed informed consent agreement? 

During the Session:

In psychedelic healing modalities, it’s important to be aware of the client’s history, values, and preferences and consider how those factors could potentially manifest during a psychedelic session. While it might be true that touch could be healing during this particular session, consent agreements are the guardrails of psychedelic work. 

During the session, the guide should remember that while they are currently – and unequivocally – in service to the needs of their client in an altered state of consciousness, they are still also expected to be in full compliance with the stated values and limits previously established by the client.

An explicit refusal of touch discussed and documented within a consent form means guides can never provide touch during a session unless a dire situation unfolds (e.g. the building catches on fire and the guide must touch the client to escort them out of the building, or a medical emergency occurs).  

An endorsement of physical touch within a consent form does not mean that touch is required, but means that touch may be ethically permissible under certain conditions. In other words, a “yes” before a session can become a “no” during the session. A “no” before a session can never become a “yes” during the session (except in emergencies as outlined above). 

In this scenario, the guide has many methods to comfort the client.  The guide could redirect the client towards self-soothing or may reassure them that they are present with their struggles and how they are safe in this moment, even in the presence of a frightening memory. 

Maintaining the boundary of no touch in that moment may in turn be a meaningful beneficial outcome, especially when processed in integration.

During Preparation:

During the preparation phase, guides and clients should discuss the complexities of touch. Having this discussion up-front is critical to your client’s emotional well-being and contributes to the development of a consent agreement with specific, helpful guardrails. Depending on the client’s history, values, and circumstances, touch could be incredibly therapeutic or it could be harmful. Guides should raise another nuanced point with clients about the complexity of touch during psychedelic sessions: in advance, some clients may clearly and unequivocably specify certain parameters on touch, but during the session, the client may detour from what was agreed-upon in the consent form. In other words, there may be a conflict between (a) the client-defined limits established in preparation and (b) the requests of the client during the psychedelics session.

Guides should share that while they are always in service to the needs and requests of their client in an altered state of consciousness, they will also always be in full compliance with the limits previously established by the client. The guide can describe non-touch approaches to supporting the client they may engage should such a situation arise, such as words of support and guidance for the client to tune into certain aspects of their experience. 

When guides are working with clients with a history of abuse, they should discuss how clients with a history of abuse may sometimes request gentle, caring holding during the psychedelics session. 

To take into account this possibility, some clients may prefer a nuanced clause on touch within their consent form. For instance, “Client states that no touch is highly preferred and will be the default. However, during the session, if the client feels safe with touch and requests it, the client gives the guide permission to place their hands on the client’s hands…” This detailed directive prepares the client and guide for a range of presentations.

This case raises a number of ethical tensions which cannot be fully explored within this limited analysis. For instance, there is much more to say about how preparation and integration practices could be conducted. Similarly, there is also the issue of which psychedelic substances may be most supportive to someone with a history of physical abuse. While there isn’t room to discuss these issues fully within this case, we may address these factors in other future cases.

None of our cases or commentaries constitute medical or legal advice; see our Disclaimers for more information.

At Gather Well we believe it is a matter of respect to the client and the depth and dynamism of psychedelic healing modalities that the preparation phase be attended with care and that it is not rushed. Clients are different and so the preparation length and preparation practices will often differ from client to client. In our programs, we teach the importance of a thorough intake process not just for medical, psychiatric or psychological contraindications, but for personal history and for sources of challenge and difficulty – and also for sources of vitality and support for the client based on their present and past life circumstances. Though it’s difficult to predict how exactly a client might express themselves in a session, there are often aspects of the client revealed during an intake and in the early parts of a preparation phase that can indicate the likelihood or possibility of certain client presentations in a psychedelic session. This can help guide the discussions in the preparation phase and lead to more nuanced agreements about touch or other interactions being made for the clients benefit. 

Once in a psychedelic session, a previously established “no touch” agreement must be maintained. If the guide perceives there may be a gray area, or something that was not explicitly discussed arises, we advocate for erring on the side of caution and providing the less intrusive support option. We recognize that, for example in this particular instance, it may be difficult to say “no” to Richard, that there may be fear that Richard could feel rejected. We encourage an approach in these instances that is caring and kind but clear in the reason why the agreement is maintained. For example-  “May I offer you support another way? I’m right here with you. You are safe in this room, and as I’m sitting here, my full caring attention is on you. I have incredible respect for the “no touch” agreement we made, and I am committed to respecting your body in this way. You might take a deep breath, feel your back on the ground, and tune into your body.”  If difficult feelings arise for Richard as a result of maintaining the agreement, we advocate for direct dialogue about it in the integration phase. Here a skilled guide can support the client in their growth and the learning that comes out of a difficult experience. Likewise, the guide can learn how they can improve their way of working in general and in particular with that client to inform any future work they do together. 

At Gather Well we believe somatic approaches, touch techniques, or simple contact, such as holding a hand, can have profound benefits to a client during a psychedelic session. While we feel this is true we also know engaging such approaches can create much greater complexity within the guide/client relationship and deserves incredible care and discernment in preparation, in consent processes, in session, and in integration. 

In our psychedelic guide apprenticeship program apprentice’s shadow and collaborate with guides during every touchpoint of the guide/client interaction. In this way the apprentice is exposed to the real nuance of these critical discussions on consent and agreement and how they may differ depending on the many variables a client brings. In this educational model the apprentice may also be exposed to ethical tensions such as this one while being supported by a guide or supervisor so learning can happen in real time. 

None of our cases or commentaries constitute medical or legal advice; see our Disclaimers for more information.

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