Presence, Trust, and Empathy: Preferred Characteristics of Psychedelic Carers

The paper situates contemporary interest in psychedelic-assisted psychotherapy (PAP) within a long history of psychedelic research that was interrupted by regulatory restrictions in the 1970s but has resumed in recent decades. Clinical investigations have explored PAP for disorders such as substance-use disorders, anxiety, depression and PTSD, and have emphasised that therapeutic support and the quality of the acute psychedelic experience are crucial determinants of longer-term outcomes. Despite growing guidance on PAP and emerging therapist training programmes, empirical evidence about the personal characteristics and competencies required of therapists and nonclinical carers remains limited. S. and colleagues sought to address this gap by drawing on practice-based evidence held by people who use psychedelics (PWUP) outside clinical settings. Specifically, the researchers conducted a qualitative thematic analysis of online forum posts to identify the characteristics PWUP prefer in carers or “trip sitters” in recreational/nonclinical contexts, with the aim of comparing these preferences to characteristics described in the clinical PAP literature and thereby informing best-practice training and guidance.

The researchers collected publicly available posts from two active online psychedelic forums—The Shroomery and The DMT Nexus—using a targeted search strategy. They constructed a search string of carer-related terms (including “carer”, “guide”, “holding space”, “hold space”, “shaman”, “sitter”, and “trip sit”) and applied it via Google’s site-specific search to identify relevant threads and posts. The procedure reviewed results up until Google indicated omitted similar entries; titles and excerpts were screened and full posts opened when relevant. The dataset ultimately comprised 403 posts. All types of psychoactive substances with psychedelic properties were considered (for example psilocybin, DMT, LSD, MDMA, ketamine, salvia and Datura). De-identification of material meant the researchers could not determine the number of distinct forum contributors represented. For analysis the researchers followed a reflexive thematic analysis approach. Two authors (LE and ST) independently coded posts, removing duplicates and irrelevant items, then met to reach consensus on preliminary codes and convert them into themes and subthemes. This iterative process resulted in 11 subthemes grouped under three primary themes. The team maintained an audit trail to support iterative reflection. Quotations from posts were used to illustrate themes and were minimally edited for de-identification while retaining original punctuation and grammar where possible. The authors also provided a reflexivity statement: all three researchers are White, tertiary educated and identify as male; LE is a long‑time member of the study forums, whereas the other authors are familiar with these communities but not active participants. Ethical procedures included contacting forum administrators before data collection, publicising the study on the forums and offering posters an opportunity to request exclusion, de-identifying and altering text to prevent re-identification, and obtaining ethics approval from Edith Cowan University’s Human Research Ethics Committee (reference 2020-01940-ENGEL).

Thematic analysis produced three primary themes describing carer characteristics valued by PWUP: presence, empathy and trust. Presence was central to posts about the immediate dynamics during an acute psychedelic experience, while trust and empathy were described as qualities desired more broadly across preparation and integration periods. The researchers emphasise that the themes overlap and are interdependent. Presence encompassed carers’ real-time contributions during psychedelic effects and was disaggregated into subthemes including comfort, calm, availability, patience, protection and existential-related roles (grounding and holding space). Comfort related to how a carer’s physical presence reduced anxiety and provided reassurance. Calm described the value placed on carers who remain emotionally steady and avoid projecting fear or tension onto the consumer. Availability referred to being nearby and ready to act while otherwise minimally intrusive; some forum posters suggested that proximity, rather than continuous physical engagement, could suffice. Patience—less frequently mentioned—was associated with the need to tolerate prolonged or repetitive behaviours that can accompany psychedelic states. Protection covered practical interventions for hazards, with forum posters listing potential risks carers might manage (for example erratic, powerful body movements—sometimes linked with 5‑MeO‑DMT—vomiting, seizures, self‑harm, unconsciousness, respiratory difficulties, environmental hazards and inappropriate behaviours). The existential subtheme captured carers’ roles in connecting consumers to ordinary reality (grounding) and in allowing profound or mystical content to unfold without interference (holding space); holding space was characterised as being nonreactive, open‑minded and nonjudgemental and as distinct from purely physiological harm reduction. Empathy comprised compassion, connection and understanding. Compassion was expressed as witnessing and supporting consumers with kindness during difficult experiences. Connection emphasised the advantage of a preexisting relationship between carer and consumer; forum posters commonly preferred friends or partners over strangers. Understanding included valuing carers’ personal experience with psychedelics or shared perspectives, which were seen to facilitate communication and empathic support. Several posts suggested that carers who had “worn those shoes” could better relate to and assist consumers. Trust was described via the subthemes predictability and preexisting relationships. Predictability covered carers’ reliability, ability to meet expectations, and capacity to anticipate consumers’ behaviours and needs; posters recommended discussing intentions and likely effects beforehand to align expectations. Preexisting relationships were frequently cited as preferable to having a stranger act as carer, with many posters warning that entrusting a complete stranger with a person under the influence is unsafe. Across the themes, forum posts indicated a preference for carers who combine emotional steadiness, practical competence and relational familiarity.

S. and colleagues interpret their findings as largely concordant with characteristics described for PAP therapists in the clinical literature, while also highlighting nuances emphasised by PWUP in recreational settings. The prominence of presence in the forum data aligns with clinical descriptions of an empathetic ’abiding presence’ but extends the concept by foregrounding minimal engagement combined with availability: the carers’ comfort being with the consumer was often more valued than active intervention. The notion of holding space was identified as a central, though variably articulated, element in forum posts; the authors note this requires more attention in PAP research and practice because it intersects with empathy, trust and grounding. The researchers observe that forum posters valued therapists’ capacity to navigate existential or mystical content, implying a need for therapists’ spiritual intelligence to contextualise such experiences. Grounding techniques and calm reassurance were repeatedly recommended to avoid projection and escalation during difficult experiences. While forum posters sometimes suggested that carer co‑consumption or lived psychedelic experience aids empathy, the authors note this is a sensitive and generally impermissible practice in clinical settings for ethical and safety reasons. Trust and predictability were linked to preparatory practices common in PAP—discussing intentions, setting expectations and establishing a therapeutic alliance prior to dosing. The authors highlight that many of the safety concerns raised by forum posters (for example vomiting, seizures, self‑harm, erratic movements) map onto risk‑management procedures used in clinical settings, where preparation, controlled environments and medical oversight are part of standard practice. The authors acknowledge limitations that constrain generalisability: the dataset was restricted to two forums and to posts returned by their search terms; forum users are likely a specific demographic that differs from typical clinical trial participants; and it was not feasible to contact individual posters or determine poster demographics. They recommend future research examine preferences across more diverse and underrepresented populations and suggest developing measures for the construct of holding space to clarify its relationship with other carer characteristics and with therapeutic outcomes. Finally, they propose that PAP training and supervision might benefit from greater emphasis on humanistic psychotherapy principles—techniques that foster presence, trust and empathy—while recognising the need for empirical evaluation of such training approaches.

The researchers conclude that preferences expressed by PWUP in recreational online forums overlap substantially with therapist qualities described in the PAP literature—trustworthiness, empathy, patience, positivity and expertise—but also emphasise the concept of holding space (presence) as a central and underexamined element. They suggest these concordances indicate certain basic humanistic therapist qualities may be broadly applicable across contexts and populations. S. and colleagues recommend that PAP training and supervision programmes incorporate humanistic principles that cultivate presence, trust and empathy, and call for further research to measure holding space, assess intercultural and demographic differences in carer preferences, and evaluate how these characteristics relate to therapeutic and personal outcomes.