Ending The Silence Around Psychedelic Therapy Abuse

Michael Pollan’s hugely influential new book on psychedelic medicine, How to Change Your Mind, is a watershed moment in calling a truce in the war on drugs. And decriminalizing psychedelics, including MDMA and psilocybin mushrooms, is, generally speaking, a good thing. But Pollan’s wide-eyed account is overly enthusiastic and largely uncritical, and there is at least one danger he and other psychedelics promoters are overlooking. All the new hype about miracle psychiatric treatments and the next wave of cures for mental disorders leaves out the risk of therapy abuse.

Therapy abuse—including therapists and doctors having sex with clients—has a history that reaches back to the early days of LSD, but you wouldn’t know that reading Pollan’s account or listening to today’s psychedelic proselytizers. Pollan seems to not understand that psychedelics, for all their strange powers, are still drugs, and therefore we need to be alert to their dangers, not just sold on their benefits. If we end the war on drugs by just medicalizing psychedelics instead, we also risk unleashing another wave of pharma marketing and commercial profiteering in a society that is daily looking more and more like Aldous Huxley’s pill-taking dystopia Brave New World.

Although I do work with people interested in psychedelics and plant spirits in my own therapy practice, and have sometimes found taking psychedelics can be useful, I wasn’t planning on writing publicly about any of this until I read How to Change Your Mind. To my surprise I discovered my former San Francisco psychedelic therapist Aharon Grossbard—and likely my own story—made a disguised appearance in Pollan’s book. And since the version I read is so different from what really happened, and Grossbard and his wife Francoise Bourzat are today leading teachers of psychedelic therapy internationally, I decided to share my own experience of being mistreated. (I provide a more detailed account of my work with Grossbard and Bourzat here.)

Background

Years of widespread use in the underground shows that psychedelics are relatively safe as far as drugs go, and far safer than psychiatric meds such as benzodiazepines or SSRI antidepressants. And there’s no doubt that, even in the much-misunderstood “rave” scene, MDMA, psilocybin, LSD and other drugs aren’t just used for escape and recreation; many users also report healing their feelings of anxiety, depression, and other emotional pain. There’s nothing new or surprising here: this has been true for decades. So by raising an alarm about therapy abuse, I’m not exaggerating the dangers of psychedelics or calling for continued drug criminalization: I’m calling for more honesty about the implications of putting psychedelics in the hands of therapists.

What’s new in the “psychedelic renaissance” is that, at a time when other medications have lost their momentum, pharma and the mental health industry are moving in on the underground market in search of money and power. And to do it they are rebranding psychedelic drugs as, well, not really drugs at all, but psychiatric treatments. In order to position therapists and doctors at the center of this new gold rush, they have to gloss over the fact that psychedelics—as weird, unpredictable, mind-shaking and life-altering as they can be—are still the same underground marketed drugs: they intoxicate you, get you high, and you come down. As Joanna Moncrieff writes, any psychoactive substance that changes consciousness can trigger a powerful experience that might feel beneficial, but the perceived benefit arises from subjective response to a drug intoxication, not a disorder cure. (And there are many other ways to induce altered states and “change your mind” without substances, such as breathwork.) The claim that psychedelics somehow treat mental disorders is as fanciful as the propaganda about antidepressants correcting chemical imbalances or lithium targeting bipolar disease.

All the gee-whiz psychedelic jargon we hear in the media today about “default mode networks,” “brain rebooting,” and “neural connectivity” is just a return of more of the same neurobabble that gave us the last wave of quick-fix faith in SSRI antidepressants. Psychiatry’s amazing new neuro-tool Prozac (and the other drugs) turned out to be just active placebos (with huge risks), an echo of Freud’s early enthusiasm for cocaine. The “second generation” antipsychotics were promoted as safer than older drugs but quickly ran up against the reality of more honest research and huge court settlements. Psychotherapy’s most recent darling, mindfulness, today has a deflating reputation in light of more nuanced and balanced research. All medical treatment outcomes are driven in part by expectation and placebo: eventually the hype around new psychiatric products wears off, and then we are on to the next marketing wave—with iatrogenic harm to patients left in the wake.

One of the great ironies of today’s interest in psychedelics is that drugs celebrated for illuminating the spiritual and aesthetic mysteries of the human mind have instead fueled a burgeoning brain research industry based on the crudest of mechanistic determinism. In their zeal to credit psychedelics with tantalizing promises of new potentials, today’s wide-eyed psychedelic advocates have gone all-in on neuroscience determinism, as if the explanatory gap of the hard problem of consciousness—how mind arises from body—were already solved. Psychologist William James’ warnings about “medical materialism” are today more apt than ever (see for example, the study “Superfluous neuroscience information makes explanations of psychological phenomena more appealing“).

Which, again, is not to say psychedelics shouldn’t be available: yes, some feel they are helpful, and continued criminalization just adds more harm. A functioning healthcare system would provide counseling for whoever needs it, and your psychedelic trip is just as valid to talk about as anything else. If you want your therapist instead of a dear friend or a spiritual guide you found online to be your tripsitter, that should be your choice. But if we get lost in brain connectivity neurobabble, draw big sweeping conclusions from small less-than real world research studies, and (most disturbingly) pander to exotic colonialism about “shamanism,” we are going to lose sight of the most important fact about the psychedelics we are about to mass market as medical treatments: these are still drugs.

And seen as drugs—intoxicating substances that get you high and that you come down from—it should be clear that among their dangers, psychedelics also pose an increased risk of therapy abuse.

Therapy Abuse

In the imbalanced power relationship of therapist and client there is already a heightened danger of authority being misused. That’s why ordinary standards of consent do not apply: a client cannot simply give “consent” to a therapist for sex, financial exploitation, physical intimacy, neglect, emotional control, or other mistreatment, The therapist, listening from powerful and distant heights to the painful secrets of their vulnerable and dependent client, has too much influence, and the consequences for clients are too severe to see each side as equal. And so we protect clients from therapists in the same way we protect children from adults, especially from the most exploitive and extreme violation of therapist trust, sex with clients. And even where mistreatment doesn’t include sexual contact, harm from emotional betrayal can be just as devastating. Therapists have an enormous special duty to protect their clients from that betrayal.

When you add psychedelics, the risks only get magnified. Drugs affect judgment, drugs can enhance idealization, drugs can promote risk taking, drugs can lower defenses, drugs can amplify suggestibility, drugs can lead to dissociation… all drugs. Imagine if you heard therapists were giving their clients alcohol to get them talkative, lines of cocaine to get them confident, or cannabis to get them relaxed? You would easily recognize that even if some clients do benefit, the client is also put into a heightened and more easily exploited state. Despite their many unique and often positive qualities, this is still true of psychedelics. And the influence is magnified when the therapist is supplier of and expert about the drug, when the drug has a taboo cultural aura of esoteric healing powers, the media are hyping miracle cures, and scientific experts are waving their hands and calling it “medical treatment.” Add that psychedelic therapists are typically also themselves users of and true believers in these substances. The dangers are obvious.

You start to see the picture more clearly: psychedelics present some of these same common sense risks of any drugs. Unless we name these risks, and are especially vigilant about them, psychedelics in the hands of therapists, though they will no doubt help some people, will also likely end up doing harm. And as the history of psychedelic therapy abuse shows, they already have.

You may want to convince yourself, as the psychedelic crusaders and entrepreneurs want you to believe, that legal medical psychedelics will somehow be immune to abuse because a therapist’s office is controlled, supervised, and safe. I disagree. I was harmed by a licensed psychotherapist and a credentialed counselor. Challenging abuse may be more difficult, not less, when it is done by someone with a license or degree.

Unlike community and underground settings with their implicit ethos of personal responsibility, reputational accountability, and “buyer beware,” drugs sold as medical treatments and administered by experts strip people of protective caution. You marvel at the hyped media accounts, invest your hope in a magic cure, rely on a doctor or therapist to take charge, and set aside your own judgment, all because they presumably have expertise that you don’t. And then if your therapist or doctor mistreats you and you try to get your voice heard and your experience seen, they have the entire power of their profession backing them up. And appealing to the licensing authorities to protect you and hold therapists accountable is a nice idea, but works about as well as appealing to the police and criminal justice system to hold any abusers accountable—as I found out in my own experience. Psychedelic medicalization risks investing even more power in this institutionally entrenched group of people.

The power to diagnose clients puts therapists at a huge advantage when challenged: labeling someone with emotional problems can effectively discredit their judgment. It is very difficult for a client to question mistreatment if the therapist blames the problem on them and says, directly or more subtly, “you’re crazy.” You came to the therapist in the first place because you doubted yourself, were vulnerable, and needed outside help. They are the expert and you depended on them. When that trust is used against you, it’s often too hard to stand your ground. Bystanders who could support you are more likely to doubt your version of the story.

This has a New Age version that cult survivors know well, a kind of “spiritual clinical gaze” where the teacher points to some presumed unenlightened state inside a challenger in order to discredit criticisms and redirect the problem back on them. The person trying to speak is labeled with a closed heart, inability to surrender, ego blockages—or just “being negative.” Once used, this tactic can become entrenched, reinforcing an entire culture of accepting abusive authority: Followers of popular Buddhist teacher Chögyam Trungpa defended his misconduct for years with this tactic, and even after Trungpa had been publicly exposed they continued in the same way for many more years to defend other abusers in their midst. It has a term: DARVO. Defend yourself, attack the accuser, and reverse the victim into the offender. You’re not the one who has done anything wrong, you are the victim of one of the “crazies” unfairly accusing you.

It’s also perilous to base drug safety on the superficial pigeonhole of a person’s psychiatric diagnosis. People need careful understanding of their specific needs: diagnoses are notoriously imprecise and offer little detailed insight into present experience. Everyone deserves informed choice about drug risks along with tailored, individual protections: Psychedelics are unpredictable, and present dangers for everyone who takes them. Pollan only adds to this confusion with his sweeping edict separating the psychedelic eligible from the ineligible: “no one with a family history or predisposition to mental illness should ever take them.” Such simplistic exclusion is a recent development: the history of psychedelics and psychosis research shows a more complex picture.

While underground psychedelics use has not worsened mental health outcomes, psychedelics can stir strong emotions that can be unmanageable. Many people, with or without a diagnosis, need special considerations (such as around dosage, frequency, and support), or might be smarter staying away entirely (and exploring alternatives such as breathwork, silent meditation, fasting, or going alone into the wilderness). Basing eligibility for psychedelic therapy on a diagnosis assumes dangers only apply to “those” people, when drug responses are diverse for everyone. Past experiences can be useful signposts, and larger doses pose higher risks, but psychiatric diagnosis itself doesn’t allow you to predict how psychedelics will affect someone.

Some psychiatric diagnoses are seen as contraindicated for psychedelic therapy, and while it seems this would protect clients, it can instead easily serve as a cover for mistreatment. If something goes wrong, the therapist can just do the diagnosing after the fact, and point to the client’s diagnosis retroactively as an excuse. Being able to “uncover” a diagnosis readily allows blame to be put on the client, not the therapist’s own behavior or drug risks. The only fault becomes not knowing the person was crazy beforehand, and now that the problem has been “uncovered”, the therapist can exonerate themselves and the treatment for anything that happened (often handing troublesome people over to psychiatry’s stigma, pills, and coercion), and move on to the next client.

Psychiatrists already routinely do a version of this when, for example, a manic reaction is blamed on uncovered “bipolar” instead of an antidepressant side effect, or violence is blamed on an uncovered “paranoid delusion” instead of a response to forced treatment. The president of my former therapy school had sex with a client and then blamed her diagnosis after she reported him; the pattern is not that far removed from abusive partners who justify themselves by labeling their exes borderline or narcissistic. Vulnerable individuals are best protected by understanding individual needs, not relying on stigmatizing and misleading diagnostic labels.

As someone who has used psychedelics and sat while others were taking them, I’ve seen how these drugs often trigger overwhelming emotions. When we are overwhelmed, we sometimes use compartmentalization, dissociation, and self-deception as ways to cope. The “high” state can become much more desirable than the old self, so you forget about things to keep yourself elevated. Anyone who has avoided making a painful decision by somehow just forgetting about it knows this basic human psychological dynamic. At the extremes, denial can become defending abusers through trauma bonding (“Stockholm Syndrome”), or the “honeymoon phase” that enables intimate partner violence. “Spiritual bypass” is another name for this, and therapists often emphasize drug-free “integration” sessions to protect against denial.

Whether on psychedelics or any other drug, it’s called getting “high” for a reason: we lose our feet on the ground. The new perspective can be illuminating, but avoidance might come as easily as insight: “Expanding” consciousness can be based on dissociation, not awareness. Psychedelics can increase suggestibility, the tendency to accept beliefs of others most strongly on display in hypnotic trance states and conditions of social pressure for conformity. It’s clear psychedelic drugs can make some people more dependent on outside influence and more unwilling to consider they have misjudged their safety.

While MDMA research has recognized the drug’s role in unwanted sexual activity (dramatically less than alcohol, for example, but still a danger), research exploring the heightened risk of ethical violations in psychedelic therapy is only now being conducted, with the publication, for example, of “A Qualitative Exploration of Relational Ethical Challenges and Practices in Psychedelic Healing” by Brennan et. al. in the upcoming issue of the Journal of Humanistic Psychology. The study scrutinizes loose professional boundaries in the psychedelic underground; within a day of announcing the paper in a community forum, authors received an email from a reader who said they were sexually assaulted by their psychedelic therapist.

Therapy Abuse and Psychedelics

From the early research days, it was impossible to see psychedelics as anything other than drugs. Like other drugs, psychedelics affect different people differently; there is not one “treatment” for everyone. LSD discoverer Albert Hofmann’s first trip was by no means enlightening: He was convinced he was poisoned by an amphetamine, and in a panic rushed a doctor to his house. Only later did Hofmann and others reframe the drug along more positive and healing lines. (Aldous Huxley’s famous epiphany under the influence of mescaline was only after he had already devoted himself to Eastern philosophy for years.)

As historian Steven Novak writes, “LSD researchers in the 1950s understood the subjective nature of drug responses and how often the results merely mirrored subjects’ personalities….” This malleability is true to such a degree that US psychiatry has repeatedly re-defined psychedelics into their opposite: first as a psychosis-mimicking substance useful for laboratory research on schizophrenia, then as a healing psychotherapy treatment, then as a mind control weapon, then as a drug of recreation and escape, and now back to a healing treatment.

Psychedelic drug response is so subjective that researchers can induce psychedelic drug highs through hypnosis or using only cues in the environment, without the person taking any drugs at all (a fact already well known in the drug underground as a “contact high“). This suggestibility, summed up in the idea of “set and setting,” undermines any simplistic claim that psychedelics are themselves treatments for mental disorders—and points to how psychedelics in the hands of therapists pose new dangers of greater influence over clients.

One of the earliest alarms about psychedelic therapy risks was first raised by leading UCLA researcher Sidney Cohen in the 1950s, when LSD was used legally in psychiatry. At first, Cohen was an LSD enthusiast whose reports contributed to the early positive media attention about psychedelics benefitting Hollywood stars and the elite. But Cohen grew more cautious when he saw therapists in Southern California become enamored of LSD’s power, obtaining LSD from manufacturer Sandoz on a pretense of being researchers and then misusing it with clients. Cohen became aware of cases of therapy abuse, and it became clear there was more harm to clients going on than was made public, hidden behind what Novak called a “veil of silence” among psychiatrists and therapists.

In a debate with the avid LSD proselytizer Timothy Leary, Cohen warned that psychedelics “expand one’s gullibility.” For Cohen, the psychedelic state was a “completely uncritical one” able to “overwhelm certain credulous personalities….the discriminating, critical capacity is lost,” he wrote. “The ability to observe oneself, to evaluate the validity of one’s ideas and swift flowering fantasies, is lost…” And what was his view of the mental health professionals drawn to using these drugs with clients? Cohen said that psychedelic therapists “included an excessively large proportion of psychopathic individuals.”

The usual narrative about why LSD and other psychedelics were made illegal goes something like this: Promising cures and fresh views of the human mind were shut down by an intolerant law-and-order culture too frightened by the antics of Leary and the hippie scene to try something new. Novak, however, challenges that story, and points to safety warnings prior to psychedelics arriving in the counterculture: “Before Timothy Leary, who first took LSD in 1961, catapulted to the national scene by being fired from Harvard in 1963, Sidney Cohen had sounded the alarm that LSD was being abused and hurting people.” In How to Change Your Mind, Pollan repeats the usual historical amnesia: His list of the reasons psychedelics were made illegal includes cultural rigidity, Leary’s provocative media stunts, and Richard Nixon’s new war on drugs. No mention of warnings about therapy abuse and client harm.

Therapy abuse continued to haunt psychedelics, including the criminalization decades later of a new drug on the scene: MDMA. In the 1980s psychiatrist Richard “Rick” Ingrasci was widely known among psychedelic researchers and therapists as a founder of the leading New Age Journal magazine and frequent presenter on the holistic conference tour circuit. He was also a crusading promoter of MDMA: He published research studies, gave psychedelics to his patients, and advocated for psychedelics prominently in mainstream media appearances, including on the CBS Evening News and Phil Donahue Show. Ingrasci worked alongside top psychedelic therapists and researchers as close colleagues, and in 1985 he even testified to the US congress that MDMA had a “low potential for abuse” and should remain legal.

Four years after his congressional testimony that MDMA was safe, Ingrasci’s photo was on the cover of the Boston Globe newspaper with the headline “Therapist Accused of Sex Abuse of Clients.” He faced allegations he raped at least three clients after giving them MDMA and other psychedelics. A series of Globe reports recounted the violence he was accused of doing to multiple women: He told one he could heal her cancer and that their sexual relationship was curative; one patient attempted suicide. Ingrasci lost his license, reached a settlement with former clients, and left the area.

Searching through the voluminous historical publications, studies, wikis, and reports in the psychedelics research world, however, I could find no accounting for or repudiation of Ingrasci by his colleagues. Not a word. No reckoning, no statement of support for Ingrasci’s victims, no gratitude for them coming forward, no “what does this mean for us.” There was also no attempt to root out any more abuse on the logical assumption Ingrasci was only the tip of the iceberg. Ingrasci was at the center of the psychedelics therapy and research scene, knew everyone, was known by everyone. And when he lost his medical license because of abuse, instead of alarms going off, it was as if that same “veil of silence” noted by Novak had again descended.

The leading psychedelics advocacy group Multidisciplinary Association for Psychedelic Studies (MAPS) cites Ingrasci on its website news section and MDMA archives as an MD, with no mention that he lost his license or why (much less a link to the cover of the Boston Globe). Erowid, a leading internet resource on psychedelics, includes Ingrasci’s research but similarly omits the abuse story. Ingrasci appears in psychedelics anthologies, and his presenter biography at the Hollyhock retreat center just says he is an MD, as if his doctor’s license were still in good standing: It describes him only as “a social entrepreneur with a rich background in psychiatry and holistic medicine.”

Another prominent researcher, a friend and colleague of Ingrasci well known among psychedelics luminaries, was Francesco DiLeo, who also faced public scandal when he was sued by a patient who alleged he sexually abused her: DiLeo told her she needed sexual touch in “fulfillment of her oedipal wishes.” (Strangely, Passie’s authoritative history of early MDMA therapy omits details of the allegations against Ingrasci, saying only that “The case of Francesco DiLeo serves to illustrate both.”) John Perry (whose innovative Jungian work on psychosis I otherwise admire), was a leading psychiatrist in Northern California with many colleagues and friends in the region’s psychedelic therapy underground: the Jung Institute expelled Perry and he lost his medical license after there were allegations of sex with some clients, some of whom went on to disrupt Perry’s public events.

Keep in mind what a sexual abuse survivor faces coming forward—personal torment, public shame, and widespread dismissal of their experience. Studies repeatedly show sexual abuse is dramatically under-reported in society, and speaking up about your therapist might be even harder. Sexual misconduct is also just the most extreme expression of misuse of power—other violations fall short of criminality but still harm clients, such as invalidating their experience, using clients emotionally, abandoning them, betraying their trust, and exploiting them financially. So it is likely that more people were harmed by Ingrasci and DiLeo than just those with the courage to come forward with allegations of crimes, and it is also likely that many more incidents of mistreatment were still to be found among other psychedelic therapists.

The Ingrasci scandal was minimized by the psychedelic leadership, but had its effects: One of Ingrasci’s victims became an advocate who worked for greater awareness of therapy abuse. She co-founded TELL, the Therapist Exploitation Link Line, a leading resource that has been quietly helping abuse survivors for decades. In the late 1980s, TELL and other advocacy groups were vital to bringing the problem of therapists having sex with patients to public awareness. The New York Times reported how new regulations were boosted when the Ingrasci scandal made headlines, expanding jurisdictions that criminalized therapist-client sex and leading to greater patient safety. But again, I could find no support for these new protections or discussion of their implications in psychedelic leadership circles at the time. Ingrasci’s multiple patient abuse scandal on the cover of the Boston Globe did have a big impact—just not in the psychedelics community.

With one exception: Allegations against Ingrasci prompted later MDMA researchers to establish the research protocol of two therapists, a woman and a man, to protect against crossing the line into abuse. The new standard, reported in Passie’s account, became a widely observed norm that continues throughout MDMA therapy research today. But even though such guidelines as the MAPS Canada study and A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder adopt this two-therapist protocol, they don’t explain why it is in place, where the protocol originated, or the risk it aimed to protect against. Clients aren’t advised they are seeing two therapists because being alone with one therapist is considered too great a risk of being sexually violated.

Richard Yensen is another prominent leader in psychedelics research for many decades and colleagues with the same psychedelics hierophants reaching back into the 1980s, including being a friend of Ingrasci and DiLeo. As Olivia Goldhill reported in Quartz, Yensen now faces recent sexual abuse allegations from 2019, not just as a psychedelic therapist but as a therapist in an official psychedelic research clinical trial in Canada. This is a remarkable indictment of psychedelic therapy safety. MAPS, who led the trial, had every opportunity to create ideal conditions for the research, given the huge stakes and enormous scrutiny of the MDMA approval process. It was a prominent, high-profile study with tremendous power and money riding on its success, and MAPS had incentive and capacity to appoint only the top qualified therapists under strict conditions and safeguards for this role. Not ending up with a therapist having sex with their client is a low-bar standard to meet.

But when MAPS appointed the therapists to run the trial, the worst-case scenario—therapist abuse and sex with a client—allegedly took place. Why? It appears the problem was still ongoing: Yensen was part of the same psychedelic therapy culture whose history reaches back to the days of abuses by colleagues Ingrasci and DiLeo.

A public lecture Yensen gave a few years ago strongly suggests that therapy abuse remains an open secret widely tolerated among leaders in the psychedelics field.

In a video of the lecture, Yensen says casually he knew of “large numbers of therapists” having sex with “multiple clients” in the 1980s. He doesn’t say if he reported any of them—or if any are still working today. And he doesn’t say if he or his colleagues have tried to do anything about it. He does, however, recount another research study years ago during which he was tempted to have sex with his client but didn’t, someone he described as a “lovely young lady.” He said he stopped himself not because he realized he needed to protect her, but because the department chairman happened to walk by and see them together. Otherwise, he admitted, “I don’t think I could have handled it.”

That Yensen would describe all this so openly, in a videotaped public lecture, suggests several things: It was accepted by his colleagues that widespread abuse was happening; Yensen feels he himself bears no responsibility; and he apparently shares the profession’s attitude of using diagnosis to blame the clients for these problems. In the lecture, Yensen described the woman he almost violated as “sexualized,” therapy-speak language to again subtly diagnose the situation as happening because of something inside the client, not because of the therapist.

Which is also what Yensen did to defend himself from the allegation that he sexually abused the MAPS client in the Canada MDMA trial. After being exposed, Yensen still wouldn’t acknowledge any mistake and instead used his diagnostic power to discredit the client he allegedly violated. According to CBC Canada,

“In a civil claim filed in B.C. in The Supreme Court in 2018, Buisson alleges she was repeatedly sexually assaulted by Yensen, with Dryer’s knowledge, while in treatment with the couple. Yensen does not deny having sex with [the client], but in his response to her lawsuit, he accuses her of initiating it, describing her as ‘a skilled manipulator.'”

“Skilled manipulator” is a code-phrase: Yensen sounds like he is subtly suggesting that the client has “borderline personality disorder,” which is a notoriously disqualifying label used to silence abuse survivors since the days when it was previously called “hysteria.” As in “you’re hysterical—you’re crazy.” Therapists who read about the Yensen allegations—and have their own challengers to contend with—may sympathize with blaming manipulation by one of the client “crazies” they are taught to fear and avoid. If a professional colleague culture is going to systematically rationalize therapy abuse, this is how they will do it: pathologizing the victims. (The president of my training school did just this, after he had sex with his client, lost his license, and continued to teach and practice at the school with the support of colleagues).

And another example: The Horizons psychedelic conference, a longstanding venue featuring leaders in psychedelic therapy and research, in 2018 had to oust prominent researcher and board member Dr. Neil Goldsmith from participating because of credible accounts of sexual misconduct. Multiple women came forward, but even after a restorative dialogue, Goldsmith apparently would not face his actions or take responsibility for the harm done. The Horizons board also announced they would “not reply to any questions about the nature of the reports that were made, or our decision-making process…This is our final statement on this matter.”

After the Yensen abuse allegations in the Canada MAPS research trial emerged, MAPS was forced to discuss the case publicly and finally address therapy abuse as a broader issue. They admitted that in their required disclosure of all the risks associated with MDMA that they hadn’t told the FDA about therapy abuse: It was kept out of the informed consent required for drug trials. They had just somehow forgotten to include this information, omitting any warning about a potential risk of MDMA so serious it had landed top MDMA researchers in trouble from the very beginning and had reshaped MDMA research protocols.

Goldhill writes:

“Yet neither the FDA nor patients were warned of that risk ahead of the trial. In all clinical trials, subjects must sign “informed consent documents,” which lay out the risks they accept by participating. Quartz has seen the informed consent document given to participants in MAPS’s Vancouver trial, which lists possible risks including dry mouth, fatigue, feeling cold, anxiety, and numbness. It does not mention that MDMA can increase sexual arousal, or warn of the history of therapists abusing patients.”

The MAPS MDMA therapy protocol also has other problems. Along with including no mention of therapy abuse or the origins of the two-therapist protocol, it prohibits sexual touch between therapist and client but, strangely, also says “If the participant wants to touch one of the therapists, the therapist allows for and/or provides touch,” and that “withholding nurturing touch when it is indicated can be counter-therapeutic and, especially in therapy involving non-ordinary states of consciousness, may even be perceived by the participant as abuse by neglect.”

The distinction between “sexual” and “nurturing” touch is never defined. Do lingering full body hugs, snuggling, spooning, or kissing a client count as nurturing, or are they sexual? Who draws that line? And why does denying client requests for touch suddenly mean a therapist risks “abuse by neglect”? Therapists routinely hold boundaries for clients who may be vulnerable and disoriented in their distress. Increased vulnerability and lowering defenses might make MDMA useful in therapy, but not if therapists are explicitly instructed to set aside customary precautions and also given the benefit of the doubt to define what is “sexual” or “nurturing.”

If therapy researchers want to introduce intimate touch into psychotherapy, they should hold this up for scrutiny directly, not quietly add it into protocols on MDMA. These vague recommendations loosen protective boundaries and are alarming in a document shaping standards for psychedelic therapy as a whole—especially after a prominent therapist chosen for a high-profile clinical trial ended up facing allegations of abusing his client.

Meanwhile, Michael Pollan’s book How to Change Your Mind doesn’t talk about any of the history of therapy abuse with LSD or other psychedelics. Pollan devotes limited attention to MDMA, despite the impact of the Ingrasci scandal, and creates a distance between MDMA and other drugs even though the psychedelic therapy leadership typically uses all of these drugs with clients, often in combination. Pollan describes MDMA in positive terms only, as “a drug famous for its ability to break down barriers between people and kindle empathy,” as if these are always good things. Sometimes those barriers are there for a reason.

My Experience with Psychedelic Therapy Abuse

I didn’t know about any of this history when I did psychedelic therapy in the 1990s with a licensed psychotherapist in the San Francisco underground, Aharon Grossbard, and was in workshops and trainings with Grossbard and his wife, Francoise Bourzat. I wasn’t seeking psychedelics, but Grossbard encouraged them as treatment. He told me the drugs were safe: no mention of the risks, no warning that all drugs have downsides, and no caution about therapy abuse. As a result, I was repeatedly mistreated, including crossing professional boundaries and violating touch. I later talked to other clients who told me I wasn’t the only one.

My experience has cautionary lessons for psychedelic medicine in general, because Grossbard and Bourzat are today both leaders in the field, teaching at the influential California Institute of Integral Studies and therapist training programs internationally. They set a standard of behavior for psychedelic therapy as a whole, including the importance of admitting mistakes and supporting survivors when they come forward. (My more detailed account can be found here; when I sent Grossbard and Bourzat drafts of this essay and invited dialogue, they replied that they had done nothing wrong and hired a San Francisco legal firm to threaten me with a lawsuit if the essay were published; the resulting legal dispute delayed publication for a year.)

Pollan interviewed Grossbard in How to Change Your Mind under the pseudonym “Andrei,” and Pollan’s portrayal isn’t just unflattering, it’s disturbing. In an echo of researcher Sidney Cohen’s earlier warnings about psychedelic therapists, Pollan meets Grossbard thinking he might take psychedelics with him as his guide, but quickly decides not to. Grossbard, he writes, “made me want to run in the opposite direction.”

(Grossbard confirmed to me that Pollan interviewed him, and what “Andrei” says is familiar to what I and other clients heard “Aharon” Grossbard say over the years. But when I sent him a draft of this essay his lawyer replied that “Mr. Grossbard’s understanding is that ‘Andrei’ is not intended to represent a single, real person, but is instead a fictional figure.” Pollan, however, is an award-winning non-fiction journalist; he introduces Andrei in How to Change Your Mind by writing that “all the people you are about to meet are real individuals, not composites or fictions.”)

Even after all these years, Grossbard was still unable to acknowledge he might have mistreated clients. Pollan writes:

“‘I don’t play the psychotherapy game,” he [Grossbard] told me, as blasé as a guy behind a deli counter wrapping and slicing a sandwich…. ‘I hug. I touch them… those are all big no-nos.’ He shrugged as if to say, so what?”

Grossbard does tell Pollan he was challenged by a client who said he mistreated him, but Grossbard doesn’t say he did anything wrong, just that it led him to decide “I don’t work with crazies anymore.” Pollan sees through Grossbard: “I told Andrei I would be in touch. The psychedelic underground was populated with a great many such vivid characters, I soon discovered, but not necessarily the kinds to whom I felt I could entrust my mind—or any other part of me.”

Reading Pollan’s portrayal of Grossbard as recklessly self-assured, I kept hearing things familiar to me: Pollan asks Grossbard, what if a client thinks they are having a heart attack, and it’s not just their imagination under the influence of the drugs, but real? Grossbard again just shrugs, and says, “You bury him with all the other dead people.” I’ve encountered that same “so what?” many times, as Grossbard smiled and with a brush of his hands and a shrug dismissed my efforts to get him to listen to how negligent he was being as my therapist.

And Grossbard’s interview with Pollan reignited deeper concerns. I am convinced psychedelics—powerful suggestibility drugs, powerful dissociative drugs—themselves contributed to my vulnerability as Grossbard’s client. MDMA is a notorious love drug that dissolves defenses and emotional protection; psilocybin at high doses can be so terrifying you rush to protection from whoever offers it to you as a “guide”; and all psychedelics confuse the ordinary self and create radical openness to suggestibility and influence. But psychedelic therapists also take these drugs themselves, often repeatedly over many years. I suspect psychedelics can magnify a therapists’ own problems—getting high can convince you that spiritual elevation entitles you to devotion from those around you and the freedom to disregard client protections.

Pollan later acknowledges that psychedelics carry this risk of putting people into such states:

“It is one of the many paradoxes of psychedelics that these drugs can sponsor an ego-dissolving experience that in some people quickly leads to massive ego inflation. Having been let in on a great secret of the universe, the recipient of this knowledge is bound to feel special, chosen for great things…. For some people, the privilege of having had a mystical experience tends to massively inflate the ego, convincing them they’ve been granted sole possession of a key to the universe. This is an excellent recipe for creating a guru. The certitude and condescension for mere mortals that usually come with that key can render these people insufferable.”

But this isn’t just a recipe for creating a guru: when mixed with the power imbalance between therapist and client it’s also a recipe for therapy abuse. Despite Grossbard openly blaming his client and these other red flags in their interview, Pollan still doesn’t connect the dots: There is no mention of therapy abuse as a risk of psychedelics in How to Change Your Mind. Meeting one of the world’s leading trainers of psychedelic therapy so unsettled Pollan he was concerned for his own physical safety, but he doesn’t mention what this might mean for the safety of other clients.

Like many survivors, it took time for me to break the spell of my conflicted loyalties to Grossbard. Drug epiphanies were at times helpful, and therapists can also be kind and generous, but things quickly took a darker turn. After Grossbard encouraged me to use psychedelics in therapy sessions, my critical thinking was set aside in favor of “surrender” and “letting go.” Grossbard told me to ignore my increasing fears about his conduct so I could “break through” my ego and rational mind. I believed he took a liking to me: I felt special, chosen to have a privileged place alongside his work.

I became a student of Grossbard and his wife, Bourzat, went to their workshops and assisted their teaching. I suddenly had two gurus I had never signed up for, enrolled under the powerful influence of drugs. I joined a secret underground circle of clients who clung onto them like a salvation, the at times terrifying drug trips reinforcing the need for safe refuge that made me seek therapy in the first place.

The relationship devolved into worse and worse professional boundary violations: staying at Grossbard and Bourzat’s home, doing childcare and landscaping work for them, going out to dinner and to a concert, hearing Grossbard’s offensive sexual jokes, him greeting me naked in his kitchen one night to tell me to keep the noise down. He held my hand in sessions. We hugged and cuddled on the office floor. He and Bourzat told me they loved me and would never leave me and I’d never be alone again. It was wonderful—until it wasn’t.

During one talk therapy session in his office, which was not using psychedelics, Grossbard continued to touch me in ways that felt sexual even after I complained: He embraced me face to face, with my legs wrapped around his waist, sitting genitals-to-genitals in his lap. The touching didn’t feel right (it certainly didn’t feel “nurturing”). So I told him, “This feels sexual.” He dismissed me by stating firmly “No, it’s not,” and continued. (California law defines sexual touching between therapist and clients to include clothed contact of buttocks with groin. I had never, then or previously, consented to any such embrace with Grossbard.) Looking back, I wonder if I was being groomed for more intimate contact.

Grossbard did all this presumably because he was convinced his spiritual healing powers entitled him to not play by the rules as a therapist—exactly what he boasted in his interview with Pollan.

After taking psychedelics two more times after this happened, it became clear my emotional problems weren’t going to be solved by a course of therapy that just included getting high, feeling you’ve discovered secret knowledge, and visits to your therapist who snuggles with you and says he loves you. Grossbard had nothing else to offer, it seemed.

I deteriorated, finally reaching a crisis point that the psychedelic-induced spiritual states could not cover over. My distress persisted, and I became bothersome to Grossbard. I fell out of favor: less attention, fewer invitations, and no more feeling special. I was set aside. With that same shrug that Pollan had found so unsettling, Grossbard told me that my downward spiral was just some personal failure of my own. To get over my crisis I needed only surrender, let go, and have unquestioning faith in psychedelics—and him. He referred me to another practitioner—a student devotee who recommended even more powerful drugs.

Grossbard’s betrayal was devastating. Without the intimate support I had depended on so deeply, I collapsed, left my school and training programs, and self-destructed my life. I plunged into an extreme emotional crisis, and admitted myself into a mental health residence where I was debilitated for months. I was not contacted by either Grossbard or Bourzat with any effort to help.

That was more than 15 years ago. Then Michael Pollan’s book was published. To make sense of what happened to me, I met others harmed by psychedelics, including people who said they were harmed by people trained by Grossbard and Bourzat, and had more discussions with the woman from the Canada MAPS trial who was studying abuse patterns in the psychedelics world. After talking with more than 10 other former clients and colleagues of Grossbard and Bourzat, I concluded I wasn’t the only one harmed, and that their San Francisco therapist colleagues had apparently enabled misconduct for decades.

Grossbard had been fined by the California Board of Behavioral Sciences for unprofessional conduct in 2015, which was reported online without any details. But there is also a 2000 lawsuit against Grossbard and Bourzat which was unavailable until a friend retrieved it from the San Francisco court. The lawsuit alleges sexual battery, fraud, professional negligence, and 12 other violations by a client of Grossbard and Bourzat who said Bourzat had sex with him. The suit points to patterns that were disturbingly familiar to me. Both Grossbard and Bourzat denied all allegations in the lawsuit. You can now read the lawsuit here.

In the suit, their former client alleges that Grossbard and Bourzat administered psychedelics without providing information about risks. He alleges that Bourzat began a four-year sexual relationship “not limited to, acts of kissing, hugging and fondling” and contact with intimate body parts including “sexual organs, groin, and buttocks… Bourzat told [plaintiff] that their kissing was therapeutic. Bourzat encouraged and allowed [plaintiff] to kiss her, as well as kissing him… On at least one occasion Bourzat told [plaintiff] that her love would heal him and that he was lucky to have her as his therapist. Bourzat told [plaintiff] she would never abandon him….” The plaintiff said he did childcare and landscaping and stayed at Grossbard and Bourzat’s home. The complaint also states the client suffered “humiliation, mental anguish and severe emotional distress” as a result of the six years of treatment by Bourzat and Grossbard.

I spoke with a former colleague of Grossbard and Bourzat who said they knew the plaintiff personally: they told me the suit was settled only after Grossbard and Bourzat made a large cash payment. They said the allegations were in fact true, that Bourzat had sex with the client, and they had even been asked by Bourzat to pressure the client to drop the suit. The colleague also told me Bourzat had sexual contact with two additional clients. And three other former colleagues of Grossbard and Bourzat corroborated this account: They told me the same thing, that the allegations in the suit were true, that Bourzat had sex with the client who filed the lawsuit, and also with two more clients.

Bourzat told clients and students she was a credentialed therapist, which implied legitimacy and accountability for their work. Bourzat had indeed been certified in Hakomi therapy—a San Francisco school closely linked to psychedelics that Grossbard and Bourzat encouraged all their students to enroll in (the MAPS MDMA treatment manual lists Hakomi alongside such methods as Holotropic Breathwork). But the Hakomi Institute chairperson and past director both told me that decades ago, before I met her, Bourzat was discovered committing what they described as “multiple ethical violations,” and her therapy certification was unconditionally revoked without possibility of reinstatement.

Crucially, Bourzat losing her certification for ethical violations was never made known, because the Hakomi Institute never bothered to tell the public about it. Other credential oversight institutions publish disciplinary action details openly, but clients, employers, and community members (and journalists such as Pollan, who publicly endorsed Bourzat’s book) had no possibility to learn that Bourzat was misrepresenting herself. She just ignored the Institute’s decision and continued to falsely represent herself in public as a certified therapist (including in her book and on her website, Amazon, Barnes and Noble, the faculty page of the California Institute of Integral Studies, and elsewhere). Only this year, decades later, did the Hakomi Institute threaten legal action after a complaint, and as a result, Bourzat stopped describing herself as Hakomi certified—and now tells people she is “Hakomi-trained” instead.

And apparently this wasn’t the only way therapists shielded Grossbard and Bourzat. I was myself enrolled in the San Francisco Hakomi training when my relationship with Grossbard was unraveling, and I turned to one of my Hakomi teachers for help and told her about the sexual mistreatment by Grossbard. She didn’t report it, refer me, or advise on what to do. Only later did I find out that this Hakomi teacher was also a psychotherapy trainee supervised by Grossbard (and had shared office space with him).

Years later, as part of writing this essay, I asked the teacher what happened: She said she didn’t remember and broke off contact, saying my emails were “aggressive” (judge for yourself here). My subsequent complaint to the Hakomi Institute was dismissed, and when I followed up with a draft of this essay for them to review and to invite dialogue, the Institute sent me a letter threatening to sue me—signed by the same teacher I had originally complained about. I later learned that all during this time, the teacher continued to have a professional relationship with Grossbard and Bourzat, being listed as a formal Advisor at the school they founded (the listing has since been removed).

Hakomi Institute represents psychotherapy practices worldwide, and, as a modality widely recommended as part of psychedelic therapy, is poised to gain even more global influence—and revenue—as psychedelic therapy becomes legal. That they couldn’t acknowledge they had done anything unethical in their response to me suggests a dangerous precedent: not taking reports of misconduct seriously, intimidating whistleblowers with legal threats, and putting conflicts of interest in the middle of complaints resolution. (And I saw the direct result: a client who says she was harmed by a Hakomi-certified therapist and Grossbard apprentice told me that, after learning how they responded to me, they would not trust the Institute with their own ethical complaint).

I also began to hear more about where Grossbard and Bourzat may have learned some of all this: from their own teachers. They trained with Pablo Sanchez, a licensed social worker and underground psychedelic therapist, and Grossbard studied with Sanchez’s teacher Salvador Roquet, a psychiatrist and prominent psychedelic therapy researcher. A close colleague of Sanchez told me Sanchez had sex with many of his therapy clients, which was known by students and colleagues. Roquet apparently regarded himself so highly he saw no problem in overwhelming clients with high doses of multiple psychedelics, graphic images of violence and pornography, sleep deprivation, and loud chaotic music to destroy their defenses and then rebuild their personalities (which has similarities to drug mind control techniques—Roquet even tortured student activist Federico Emery Ulloa with psychedelics at the request of the Mexican government). Grossbard and Bourzat’s group psychedelics session format was learned from Sanchez and Roquet.

Grossbard’s school dissertation enthusiastically endorses Roquet and Sanchez’s therapy. Grossbard writes, “Participants are pushed to their limits in order to help them see more clearly their fears and blocks and break through them by surrendering and by allowing the disintegration of their intellectual and rational patterns of their relating to reality.” Unquestioning surrender is implicit as clients are moved through an assembly line to tear them down and rebuild them. Any challenges or criticism are just “blocks” and “rational patterns.” The word “consent” is nowhere to be found in Grossbard’s dissertation, much less any discussion of therapy abuse. And another student and close colleague of Roquet who endorsed his method? Richard Yensen, the MAPS therapist casually describing sexual abuse on YouTube.

Looking Forward

Despite my own run-in with psychedelic therapy abuse, I do believe it’s a good thing to stand down from the war on drugs. I am also encouraged, to a degree, that some people will choose psychedelics as a safer option than traditional psychiatric drugs, as it appears is happening with cannabis. But just as legal cannabis is being distorted by huge commercial interests, making doctors, therapists, pharmaceutical companies, and capitalist entrepreneurs in charge of who gets to trip on legal psychedelics poses new dangers. Marketing hype and enthusiastic journalism such as Pollan’s will likely fuel another cycle of psychiatric industry profiteering, with the high expectations of quick fixes eventually crashing down to a more complicated reality. And if the history of psychedelic therapy abuse remains hidden, the misconduct of leading teachers in the field goes unchallenged, and survivors are left unsupported, even more patients will be harmed.

Community-controlled decriminalization, not medicalization or full commercial legalization, is a better path to end the war on drugs without just handing power over to professional and pharmaceutical cartels. People should be able to grow and share plants for personal use, get permits for manufactured chemicals like ketamine or LSD, or join churches where psychedelics are sacraments. At the same time, taking psychedelics safely will be up to local communities: We need active community oversight and accountability at the grassroots level, because therapists, professionals, or pharma—much less the criminal justice system—aren’t going to do it for us (even with all the promises of regulation and alternatives to police). That means speaking out, not just staying silent and leaving safety to the experts.

When mistreatment won’t be acknowledged privately, the next step is to speak publicly—otherwise, we start to become part of the same “veil of silence” that LSD historian Novak saw at work in the 1950s. That means also speaking out about communities that have gone along with abuse, and making transparent processes of transformative justice a regular part of our lives.

The mystical revelations of psychedelics may ease our suffering, but as psychologist William James pointed out, they mean nothing if they leave us afraid to take moral action. What is needed above all is for communities to realize that we have to take care of each other in an increasingly chaotic world, and that means we all have a shared interest in holding each other, and ourselves, openly accountable. And when conflict goes public, it needs to follow the lead of Dr. King’s nonviolence truth-telling: replace tribalism and the outrage politics of us versus them with mutual regard and an invitation for change, not vilification and scapegoating. No one is beyond redemption, and once pathways for return are clearer, therapists might be more likely to admit mistakes and come forward, colleagues might feel more free to break loyalties, and therapy as a whole might create more ways to support clients who have been harmed.

Aldous Huxley’s prescient Brave New World anticipated today’s disastrous embrace of mood-altering pharma drugs; he also warned that the transcendent raptures of psychedelics could easily become just more meds in the arsenal of adapting to a dystopian society. Instead, what is meaningful about psychedelics is how they inspire our primal need for community healing rituals and true loving solidarity, places where we can free our emotions and open our hearts to the yearning for spiritual connection with each other. Not with experts, not with professionals, and not with healers held above others. Overcoming the fear and isolation between us is the pathway to our true salvation. And there’s no pill for that.

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Editor’s note: “This essay was updated from an earlier version to correct information about John Weir Perry.”

Editor’s Note: Will Hall’s detailed personal account of his experiences can be found here.