Therapists’ Perspectives on the Psychotherapeutic Support in Psilocybin Treatment for Major Depressive Disorder: Insights from a Randomized Controlled Trial

Abstract Psilocybin treatment has emerged as a promising intervention for Major Depressive Disorder (MDD). However, the contribution of psychotherapeutic support to treatment outcomes remains unclear. This study explored therapists' descriptions of their work during a randomized, double-blind, placebo-controlled psilocybin treatment phase II trial for MDD. Nine therapists participated in semi-structured interviews focusing on (a) specific psychotherapeutic activity, (b) treatment structure and content, and (c) treatment active components and outcome. Data were analyzed using thematic analysis. The analysis resulted in four themes. The first involves the therapists’ reflections on the role of the psychotherapeutic support. The second includes their functions and specific approaches and techniques used. The third describes how the therapists experienced providing psychotherapeutic support within a clinical trial. The final theme describes various aspects of the therapists’ experiences with the double-blind study design. Therapists considered psilocybin treatment beneficial for psychotherapy and described the psychedelic experience as facilitating therapeutic processes. They also described how they used specialized psychotherapeutic skills during sessions. Current research has yet to determine whether psychotherapeutic support is an essential component of psilocybin treatments. Future research should clarify the role and optimal structure of psychotherapeutic support.