Home / Questions from the field / Consent, power and boundaries

Consent, power and boundaries between guides and participants

People ask about agreements before a session, touch, transference, the line between sharing and intrusion, and what happens when a guide crosses a boundary. This card sets out what is reported, what research has found and what we did not find measured.

Published Information current to 3 November 2026Review due by 1 February 2027

Read this first. This page is education, not instructions to use. Metanoia does not supply any substance. In the United States, most of the substances discussed here are Schedule I under federal law (21 CFR 1308.11). State programs such as Oregon's and Colorado's operate under state law only, and federal law still applies. Legal status differs between countries, and none of this is legal advice. Nothing here is medical advice, and nothing here describes or recommends a dose. People who host, supply or take part in sessions involving controlled substances can face criminal liability under federal and state law. This page does not advise on that. "Healthy adults" means people with no diagnosed psychiatric or major medical condition, the population Metanoia studies. This page reports what published sources say about work done outside supervised programs, and it takes no position on the legality of any setting, practice or person.
Not an emergency resource. Metanoia is not an emergency service. If you are in danger now, in the United States the number is 911, and the 988 Suicide and Crisis Lifeline is available by call or text. Elsewhere, local emergency numbers apply. Metanoia does not receive or investigate complaints about guides or retreats.

The short answer

What do sources say about consent, touch, power and boundaries between guides and the people they guide?

The sources describe concern more than they describe protection that has been tested. Reviews of the ethics literature describe doubt that full informed consent can be given before an altered state, and they describe boundary violations as a recognized source of harm, because the participant is more sensitive and suggestible and cannot leave while the substance acts. In an interview study inside one clinical trial, participants who accepted touch under agreed rules tied it to a strong relationship and an explicit consent process. No study located measures whether a code, supervision or screening prevents harm, and no figure for how common abuse by guides is was located. This card does not say who can be trusted, how to choose a guide or what to do when a boundary is crossed.

What do people in the field ask?

Reported practice, not a recommendation. This marking applies to everything in this section.

Method note. Metanoia collected these questions from public community posts and organization pages on 3 November 2026 (10 items on ethics, boundaries and exploitation, and a few from neighboring topics). It is one collection in one session. It is not a sample of the field, and the count says nothing about how common anything is. Most claims in those posts about particular people and retreats could not be verified, so this section lists the questions people ask and repeats no accusation. Level 3 names a type of source and does not rank its quality. Nothing is quoted and no person or organization is named.

  • Should there be a written agreement up front? Posts suggest a formal agreement with the participant before the session, with safety limits and defined points for calling a friend, leaving or calling emergency services.
  • What about transference and falling for a guide? Posts express concern about exploitation and advise against playing the guru.
  • What about touch? Posts describe touch as powerful and possibly harmful. They say not to touch without the person's permission or initiative, and to avoid sexual touch.
  • Where is the line between sharing and intrusion? A participant asks where the line runs in conversations after a ceremony.
  • Should a guide be exposed publicly? A post asks whether to expose a guide after a bad experience. The account behind the question was not verified.
  • Who oversees the guides? A podcast description discusses dual relationships and peer “wisdom circles”.
  • Should a therapist share a journey of their own? A therapist asks whether to briefly tell an interested client about a personal experience, and separates what helps the client from the therapist's own enthusiasm.
  • Accounts of harm at retreats. Posts carry anonymous accounts of harm at retreats. Metanoia did not verify any of them and does not repeat them.

What does research know?

Most of this comes from reviews of the ethics literature, an interview study inside a clinical trial, surveys of providers and retreats, and one data set from a support line. Much of the literature reviewed concerns clinical settings and not ceremonial guides. Where the text describes what sources suggest or what programs do, it is reported practice, not a recommendation.

Reported practice, not a recommendation. This marking applies to everything in this section.

The items below describe what a trial, a review and a code say. They are not a protocol and not a recommendation.

  • Interviews inside a clinical trial of psilocybin in Australia (generalized anxiety) covered 18 participants chosen from 62 (39 interviews). The trial allowed minimal supportive touch, such as holding a hand, under a consent that was set in advance and could be changed between sessions. It banned sexual or sensual touch and somatic therapy, and it used therapist teams of mixed gender. All participants agreed to the principle and most received touch. Source 1, level 1, 2026
  • Most participants valued the availability of touch, described emotional connection and grounding in intense sensations, and some described a benefit they attributed to touch. Others described discomfort or distraction. This is perception and not a measure of outcome. Source 1, level 1, 2026
  • Participants tied consent to the quality of the therapeutic relationship and to an explicit consent process. The authors note that participants described a strong relationship as a condition for touch, which runs against a claim in the literature that touch strengthens the relationship. Source 1, level 1, 2026
  • The authors write that touch is a boundary crossing, that a structured discussion after the session might keep a boundary crossing from turning into a violation, and that programs with more intensive touch probably carry higher risk. No participant in the interviews reported a significant negative effect. They list an industry-sponsored trial, a homogeneous sample, psilocybin only, a minimal protocol, and no reflection of guides in the community. Source 1, level 1, 2026
  • A 2026 scoping review covered 51 articles (search in April 2023, 9 of them empirical) and a consultation workshop of eight participants. On consent (16 articles), it describes doubt that full informed consent can be given before a session, because of media hype, pressure, the impossibility of describing the experience and earlier experience. It also describes the difficulty of consenting to touch in an altered state. Source 2, level 1, 2026
  • The literature reviewed suggests consent before the session and a check again during it, touch only on request, and documentation. Source 2, level 1, 2026

What do sources describe about power and boundaries?

  • In 15 of the articles in the scoping review, boundary violations are discussed as a possible source of harm and exploitation and of dual relationships, and as arising from sensitivity and heightened intimacy. Vulnerability is described as arising from the inequality between guide and client, from intimacy, from heightened sensitivity and suggestibility, and from the participant being unable to leave while under the influence. Source 2, level 1, 2026
  • The literature proposes self-awareness, clarifying expectations before the session, documenting consent, reporting violations and accountability. It addresses mainly clinical settings and not ceremonial guides. Source 2, level 1, 2026
  • A 2021 legal and ethical analysis for US clinicians doing harm reduction and integration work (not guiding during a session) writes that ethical standards are not well established. The authors call for a code of ethics for this work in future, like the existing one for MDMA. They say clients may not know that “underground” guides have no regulatory oversight, and that retreat sites may be tourism businesses outside medical oversight. This is opinion and analysis. Source 3, level 1, 2021

Do guides take the substance during ceremonies?

Reported practice, not a recommendation. This marking applies to everything in this section.

  • In interviews with 49 retreat organizations (July to October 2023), 29 (59.2%) said that facilitators use the substance in ceremonies, and 4 of them made clear that a sober person is always present. In two religious organizations with no licensed or emergency-trained staff, sober volunteers were asked to stand by. The authors say a guide's own use is common, and even considered necessary, in some Indigenous traditions such as Peruvian vegetalismo, and that it marks a gap between a clinical and a traditional point of view. Source 4, level 1, 2026
  • The scoping review says some see value in a therapist's own use, for trust and understanding, and others warn that it may impair judgment. Source 2, level 1, 2026

Who are the guides, and who is present?

  • Of the 49 retreat organizations, 21 (42.9%) had worked with at least one licensed health professional, and 20 (40.8%) said one was present at the retreat. The authors note that professionals abroad may not be licensed to work under their licence, and that their working ties to the retreat are not always clear. Source 4, level 1, 2026
  • In an anonymous convenience survey, 107 people who said they provide services reported the following. 59.8% held no full licence and were not in the process of getting one, 44.9% had no degree related to therapy, and training was mostly self-directed (personal experience 88.8%, books and seminars 78.5%, university 16.8%). 96.3% screen clients in some way. The authors write that people without a licence are not subject to standards of training, continuing education and ethics, and that clients may be exposed to boundary violations. This is the authors' view. The sample is a convenience sample with no verification. Source 5, level 1, 2025

What do codes and governance frameworks say?

  • One academic training program in Canada (a yearly certificate since 2022, 219 students in four cohorts) published a competency framework and a code of ethics. The authors write that it is not a consensus standard and not an externally validated model, that no outcomes were measured, and that it should not be assumed to transfer without adaptation. Some of the authors are faculty of the program. Source 6, level 1, 2026
  • The code covers these areas: safety and harm prevention, cultural responsibility and reciprocity, confidentiality, transparency and ongoing informed consent (including roles, costs and recordings), therapeutic alliance, power and boundaries (avoiding dual relationships, supervision), touch and sexual boundaries and consent in an altered state, financial ethics, and competence and accurate representation of credentials. On touch it says that it needs explicit consent in advance, a defined purpose and accountability processes, and it calls sexual boundaries unequivocal. Source 6, level 1, 2026
  • Students sign the code or propose amendments before practical work. When a dilemma has no expected precedent, they are expected to gather information, consult and, if needed, involve a third party, including appropriate authorities. The paper describes no complaints procedure. Source 6, level 1, 2026
  • The scoping review notes that there is no legal credentialing system for guides, no agreement on what counts as skilled practice, and that workshop participants said the training of guides is not regulated. Source 2, level 1, 2026

What does a support line record about reports of abuse by a guide?

  • At one US support line staffed by trained volunteers, 43 of 25,419 interactions were classified by the volunteer as a report of abuse by a facilitator. The line did not investigate, verify or decide on reports, and did not collect identifying information about the guides named. Source 7, level 1, 2026
  • Of 27 interactions with a coded substance, 11 involved ceremonial or plant substances (ayahuasca, 5-MeO-DMT, San Pedro, iboga). The numbers are small. Source 7, level 1, 2026
  • The authors list one service, only people who sought help, unverified coding by volunteers and small numbers, and they say no prevalence in the population can be inferred. They add that the protocol pointed callers to a peer support forum, and that callers were supported in their own decision about action. Source 7, level 1, 2026

What do sources say about complaints and accountability?

  • The state psilocybin program of Oregon says on its complaint page that it will investigate complaints, incidents or concerns about violations of the state law and rules that occur at a licensed premises and during the provision of services, and that it decides whether a possible violation exists and whether it has authority. It investigates only violations of that state law, and for criminal activity the page directs people to law enforcement. It says there is no legal duty to file, and that if a violation is found the complaint may be used in an administrative proceeding. This describes a page read on 3 November 2026 for one state. Official pages change, and the page was not checked again. Source 8, level 1, 2026
  • The support line described above does not verify reports or collect identifying information about guides, and the paper describes no route from the line to a regulator. Source 7, level 1, 2026
  • The authors of the 2021 analysis note that licensing boards for professions may take complaints about clinicians from clients, colleagues or the public. This is a note about the US licensing system and does not apply to guides who are not licensed. Source 3, level 1, 2021
  • The scoping review reports proposals for reporting violations and accountability, and one article's proposal of a public-private regulation that would allow a mechanism for compensating injured people. That is a proposal and not a practice. Source 2, level 1, 2026

What is not known?

“Not located” means that the searches Metanoia ran on 3 November 2026 did not return it. They covered PubMed (four search strings), Europe PMC including preprint servers, and one official government page. More searching could change the picture.

  • How common abuse or boundary violations by guides are in any population. A prevalence estimate read in full was not located. The one source read is support-line data (7). A survey on inappropriate sexual contact by guides was found and read only as an abstract, so this card makes no claim from it.
  • What happened to complaints. Whether they were investigated or led to a sanction was not located, in Oregon or elsewhere. The official page describes a route and not results (8).
  • Whether a code of ethics, supervision, screening or training reduces violations. A study was not located. The framework describes a program and measured no outcome (6), and the scoping review notes there is no agreement on what counts as skilled practice (2).
  • Complaint routes in other states and outside the United States. This card did not examine them.
  • How communities inside traditions deal with a violation by a healer. An ethnographic source on this was not located among the texts read. The papers on Santo Daime, Peruvian dieta and Saraguro describe roles and hierarchy and not accountability mechanisms.
  • Touch and sexual conduct in traditional ceremonies that are not clinical. An ethnographic source was not located among the texts read.
  • Whether a guide's own use of the substance changes safety. The sources hold opposing views (2, 4). A study was not located.
  • Ethics from the point of view of Indigenous guides. The scoping review notes that only 2 of its 51 articles consulted Indigenous people or stated an Indigenous background (2).
  • Other papers. Papers on touch from researchers' viewpoints, on standards of care built by experts, on the ethics of integration groups and on cult-like dynamics in practice were found and not read in full, so this card makes no claim from them.

What do traditions do?

Reported practice, not a recommendation. This marking applies to everything in this section.

Level 4 names a type of source: interviews with healers and the observation of an author. The papers are peer reviewed. They describe the views of a few healers or of one author, and they do not stand for any tradition as a whole. No source on how a tradition defines a violation by a healer, on sanctions or on complaints was read.

  • In one branch of Santo Daime, as one author describes it, the space is divided into separate sides for men and women, and where a participant sits reflects standing in the group, with those of higher standing nearer the center. According to the author, the division reinforces personal space and discourages physical touch. Members attend the same church for years, and long-running conflicts in the community can last for years. The paper describes no complaints mechanism. The author also notes that members' commitment to serve the church can turn into spiritual injury when they overextend. Source 9, level 4, 2021
  • Ten Kichwa healers interviewed in Saraguro, Ecuador, gain standing in the community by how well they heal, according to a community leader quoted by the authors. The paper puts it that effectiveness screens out charlatans, and it says healers direct patients to Western medicine when a condition cannot be treated by experience. They note that 65 healers are registered with the provincial health department. The paper describes no mechanism for claims against a healer. Source 10, level 4, 2014
  • Eight healers interviewed in Peru stress that a dieta should be run by someone who knows and is prepared, and that a broken rule is treated by a skilled healer. The paper describes no mechanism of accountability. Source 11, level 4, 2021

What this card does not say

  • It does not say who can be trusted, how to choose a guide or what to ask one.
  • It does not say that any rule, code, credential or training makes a guide safe, or that its absence makes a guide unsafe. No study located measures that.
  • It does not say how common abuse by guides is, and it does not call it rare or common. The one figure comes from a support line, is unverified, and is not a rate in any population.
  • It names no person, guide, retreat or community, and it repeats no accusation.
  • It does not say what to do when a boundary is crossed or where to complain. The Oregon paragraph reports what an official page said on 3 November 2026 and applies in that state only. It is not legal advice, and it does not cover other states or countries.
  • It does not say what is allowed or forbidden in any traditional ceremony.
  • It does not recommend touch or avoiding it.
  • Metanoia does not supervise guides, receive complaints about guides or certify anyone.

Related elements in the Metanoia Exposure Record

These elements of the draft data element set (version 1.1, open for comment until 2 December 2026) ask about the same area. This list makes no claim about what the set covers or leaves out. Read the data element set.

Send a correction

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Where does this come from?

Grade key: 1 = peer-reviewed publication, official document or primary record. 2 = reliable secondary source. 3 = grey source (community, social media, organization pages). 4 = traditional or ethnographic source. A grade names the type of source, and the design and limits are given in the text. "Full text" means Metanoia read the body of the paper in full on 3 November 2026, and any part not read is named. A source read only in part carries no claim on this card. Sources described in the text as found and not read carry no claim and are not listed.

  1. Ham R et al. Participant experiences of therapeutic touch in psilocybin-assisted therapy. Brain Behav 2026. DOI 10.1002/brb3.71262 PMID 41699875. Grade 1. Qualitative interviews inside a clinical trial. Full text (supplement not read).
  2. Brittain N et al. Ethical issues and recommendations in psychedelic research and practice: a scoping review. J Bioeth Inq 2026. DOI 10.1007/s11673-025-10454-3 PMID 40773130. Grade 1. Scoping review. Full text (appendix not read).
  3. Pilecki B et al. Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduct J 2021. DOI 10.1186/s12954-021-00489-1 PMID 33827588. Grade 1. Legal and ethical analysis, which is opinion. Full text (the appendix of reflection questions not read). Its statements on US law are not used.
  4. McGuire AL et al. Reported Safety Practices of Publicly Advertised Psychedelic Retreats. JAMA Netw Open 2026. DOI 10.1001/jamanetworkopen.2025.52505 PMID 41499117. Grade 1. Qualitative interviews with 49 organizations. Full text (tables read in brief). The paper does not test links between practices and outcomes.
  5. Glynos NG et al. Going underground: demographics, services, and best practices endorsed by practitioners providing support for naturalistic psychedelic use. J Psychoactive Drugs 2025. DOI 10.1080/02791072.2024.2405685 PMID 39297183. Grade 1. Convenience survey, self-report by providers. Full text.
  6. Dames S et al. Competencies and Ethical Governance for Psychedelic-Assisted Therapies: A Practice-Embedded Quality-Improvement Framework. J Eval Clin Pract 2026. DOI 10.1111/jep.70556 PMID 42574657. Grade 1. Framework from one training program, not externally validated. Full text (supplements S1 to S3 not read).
  7. Schoeller F et al. The Fireside Database: Large-scale evidence from 25,419 psychedelic support interactions. Sci Adv 2026. DOI 10.1126/sciadv.aeg4737 PMID 42962007. Grade 1. Descriptive service data, unverified coding. Full text (supplementary material not read).
  8. Oregon Health Authority, Oregon Psilocybin Services. File a Complaint. Grade 1. Official web page. Full text (a short page), read on 3 November 2026. A live page that may change.
  9. Hartogsohn I. Set and setting in the Santo Daime. Front Pharmacol 2021. DOI 10.3389/fphar.2021.651037 PMID 34017252. Grade 4 as source type (descriptive analysis and personal observation by one author), published in a peer-reviewed journal. Full text (one figure not seen).
  10. Armijos C et al. Traditional medicine applied by the Saraguro yachakkuna: a preliminary approach to the use of sacred and psychoactive plant species in the southern region of Ecuador. J Ethnobiol Ethnomed 2014. DOI 10.1186/1746-4269-10-26 PMID 24565054. Grade 4 as source type (ethnographic interviews with ten healers), published in a peer-reviewed journal. Full text.
  11. O'Shaughnessy DM, Berlowitz I. Amazonian medicine and the psychedelic revival: considering the “dieta”. Front Pharmacol 2021. DOI 10.3389/fphar.2021.639124 PMID 34149407. Grade 4 as source type (ethnographic interviews with eight healers), published in a peer-reviewed journal. Full text.