In December 2025 I started writing a column for Psilocybin Alpha’s new publication, ‘The Psychedelic Practitioner’, alongside my friend and colleague Dr Bryony Insua-Summerhays. I include our introductory spiel, and first piece, on psychedelic preparation, below. Click the link above to read any further writings.
We come to this column from complementary directions. Eddie holds a PhD in the ethics of psychedelic therapies, and is now at Johns Hopkins’ Center for Psychedelic and Consciousness Research, deepening his grasp of the science and clinical practice so he can build better bridges between ethics and the realities of the work. Bryony is a senior clinical psychologist in training as an analyst, which means she’s spent years in rooms where the rubber meets the road: sitting with what’s actually happening between therapist and client, where tidy ethical frameworks meet untidy humans.
Our shared conviction that guides this column is that ethics isn’t about a credential or a set of rules that you can memorise or master. Readers hoping for prescriptive right answers will find themselves disappointed. As we see it, ethics is something you do, often imperfectly, in real time, under uncertainty. We’ve both encountered situations where the guidelines didn’t quite fit, where competing values pulled in different directions, where we genuinely weren’t sure what the right call was.
This column is for practitioners (and aspiring practitioners) who recognise that feeling. Not because we have answers that you don’t, but because we think the questions are worth taking seriously together. We’re interested in the places where reasonable, thoughtful people disagree – and why this might be. We won’t pretend that thinking carefully always yields clear answers, but we believe it yields better practitioners: ones who can weigh competing values, sit with complexity, and make difficult calls with eyes wide open.
A first preparation session often begins with a familiar scene: a new client sits down quoting Pollan or talking of “ego dissolution” and “connecting with the universe.” Their expectations arrive fully formed. You face a decision: open the frame or leave it intact, knowing it may shape the session. What people expect going in can shape – or constrain – what they experience. Expectation will be shaped either way. The only variable is whether you notice.
The Influence You Can’t Avoid
Psychotherapists have long grappled with the ethics of influence. Freud urged analysts to practise “evenly suspended attention”, a neutral openness intended to avoid steering patients toward particular insights.
This idea of neutrality-through-absence has a long reach, including to some psychedelic quarters: strip away the spiritual tchotchkes, the curated playlists, the warm furnishings, and what remains is neutral ground. Some early researchers fell into this trap: one study administered 800 μg of LSD to patients strapped to a hospital bed, explicitly omitting the music, imagery, and environmental supports other investigators were already seeing as therapeutic.
In trying to isolate the drug’s action, the researchers created a context of their own: clinical, austere, sterile. Unsurprisingly, results were no better than placebo. Such neglect of context, we now understand, might render a psychedelic experience clinically ineffective or potentially harmful. There is no neutral context. ‘Absence’ is simply a different kind of influence.
Expectation, Priming and Epistemic Trust
Many clients arrive already primed: uncertain, expectant, looking for orientation, giving small suggestions significant weight. Epistemic trust – the sense that someone can be relied on to offer information that is accurate, relevant and safe to take in – makes this even more central. Once established, it can act like a psychological lever. A client told that “resistance blocks the process” may later interpret ordinary difficulty as a problem – or a failure. Someone primed to expect “ego dissolution” may view depersonalisation as either breakthrough or crisis, depending on its framing.
Expectation shapes interpretation – that much is uncontroversial. Perhaps less obvious is how directly this can migrate into the acute experience. Psychiatrist Mortimer Hartman noted this decades ago, observing that Jungians practising psychedelic therapy elicited transcendental material from their patients, while Freudians evoked patients’ childhood memories. Recent work has reported similar. In a trial of psilocybin with CBT for smoking cessation, some participants reported acute imagery that mirrored that described in preparation – visions seemingly lifted straight from the manual. When epistemic trust is high, preparatory cues can become the architecture of experience. How far such framing effects extend to outcomes, rather than just experience content, remains genuinely unclear. But when epistemic trust is high and defences low, even modest influence may land with unexpected weight.
Steering the How, Not the What
Most protocols try to offer enough structure for safety without corralling the session. Hence the emphasis on process rather than content: stay curious, breathe through difficulty, let experience unfold. These orient people to how to meet experience rather than what to expect.
Yet process cues carry values too: “letting go” makes “holding on” problematic. “Trust the process” positions doubt as obstacle. These ideas have specific lineages – mindfulness, humanistic psychology, the countercultural history of psychedelic work. They may have value, but they are not neutral. Psychedelic sessions – like psychological life in accelerated form – often move through pockets of stuckness before they resolve. Framing fear or stuckness as part of this normal rhythm helps prevent clients from interpreting these states as threat or failure and keeps the frame broad.
Influence Without Agenda
Contemporary psychoanalytic thinking offers a different vision of neutrality: not blankness, but an active awareness of how timing, tone and phrasing shape the psychological field, with influence used to support openness, rather than steer toward a predetermined experience.
Balance is worth attending to. Too little structure leaves people uncontained; too much funnels them into a narrow corridor of expectation. Keeping influence process-focused preserves a middle ground, offering attitudes with which to meet experience rather than accounts of what may emerge. It also acknowledges that the frame stretches well beyond the dosing day: preparation and integration shape meaning just as much as anything that happens within the dosing session.
Some practitioners turn to the evidence base for reassurance. Yet here, the evidence is thin. Systematic reviews find that most psychedelic trials fail to report basic intervention details, or don’t share their manuals. And when those elements are reported, psychological interventions vary wildly. We simply don’t yet know which work better (or for whom), or even what approaches were actually delivered in published trials. This puts greater weight on practitioners’ own assumptions, making it all the more important to know what those assumptions are and how they enter the room.
A Question to Carry
Every clinician brings their own commitments into preparation: theoretical preferences, clinical instincts, personal values. Because they may feel obvious or benign, they are easier to overlook. In psychedelic work, where clients are unusually receptive, these unexamined assumptions can take on the force of explanation, as if they were simple facts about “how the medicine works”. This brings the ethical question into focus:
Are you preparing someone for the experience you expect, or helping them meet the experience they’re likely to have?
The difficulty isn’t influence itself, but influence that goes unnoticed. Preparation shapes the conditions in which the experience can unfold, be endured, and ultimately be made meaningful. The more transparent practitioners are about the values guiding that shaping, the more ethically grounded – and clinically useful – the work becomes.
Psychedelic Ethics 