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Suggestibility is “the propensity to respond to suggested communication” (Schumaker, 2026, p. 3). This entails a tendency to adopt others’ ideas, beliefs, attitudes, or actions uncritically (APA, n.d.)—thus leaving people feeling vulnerable by bypassing their critical thinking, as their capacity to separate fact from fiction is compromised.
Suggestibility is particularly relevant in psychedelic-assisted therapy, or PAT. What has been called the “psychedelic renaissance”—the resurgence of research on psychedelic substances for mental health conditions after decades of inactivity—requires greater critical thinking to prevent the field from “going off the rails” due to commercial pressures, unintended consequences of medical harm, and the conflation of science with broader cultural agendas.
Why Suggestibility Matters in Psychedelic-Assisted Therapy
PAT uses substances like psilocybin, ketamine, LSD, or MDMA, which have been found to reduce rigid neural activity and cognitive rigidity while promoting neuroplasticity and fostering an open and highly associative mental state (Kishon & Cycowicz, 2025). On the other hand, by diminishing decision-making capacity, reducing controllability, and limiting resistance to external influences (Villiger, 2024), this altered state of consciousness can significantly amplify an individual’s responsiveness to environmental sensitivity, psychological framing, and suggestibility (Dupuis, 2021).
In addition to the above, there is a paradoxical effect of suggestibility in PAT. While the effects of suggestibility can improve psychotherapy outcomes, it can also “act as a significant confound in research in therapeutic interventions” (Stein & Terhune, 2025, p. 449) by shaping people’s responses in ways unrelated to the substance and making its impact appear larger than it is.
Hence, within the expanding practice of PAT, suggestibility warrants greater attention (Oliver et al., 2024), and its role has moved to the forefront of clinical and ethical discussions in this emerging field (Villiger, 2025). This article provides the latest research on strategies available for protecting against suggestibility in PAT.
3 Types of Suggestibility in Psychedelic-Assisted Therapy
There are three main types of suggestibility: primary, secondary, and tertiary.
Primary or hypnotic suggestibility relates to the involuntary execution of movements, altered sensory processing, and a heightened state of absorption in response to direct suggestion.
Secondary suggestibility refers to indirect, nonverbal cues that influence perception or cognition, in which the desired behavior or outcome is not made explicit. In PAT, this type of suggestibility relies on cues from the imagination, context, or environment—that is, the therapeutic “set and setting,” which refers to one’s mental state (“set”), and the physical space or social environment where the psychedelic experience takes place (“setting”).
Tertiary or interpersonal suggestibility is the easy, uncritical acceptance of someone’s recommendation due to social pressure or the authority and prestige of the person making the recommendation.
Interpersonal or contextual suggestibility is particularly relevant in PAT, as psychedelic compounds enhance suggestibility, and their psychological effects are context-dependent. This means that the content and subjective quality of the experience are shaped by the clients’ surroundings and the therapeutic alliance or relationship with the therapist (Villiger, 2024). This relates to the client’s tendency to be influenced by the therapist’s verbal cues and social context during the psychedelic state. In sum, given the heightened vulnerability and suggestibility that can occur during PAT, client safety becomes critical (Kim et al., 2026).
How to Manage Suggestibility in Psychedelic-Assisted Therapy
The latest research identifies protective strategies across the three phases of PAT: preparation, dosing, and integration, or the post-dosing sessions dedicated to exploring and making sense of the experience and translating insight and new perspectives in daily life.
Psychedelics Essential Reads
1. Preparation (before the session)
A key pre-treatment safeguard during preparation entails obtaining robust informed client consent, with explicit attention to the heightened suggestibility and vulnerability that the PAT creates. In fact, PAT requires enhanced consent by going beyond standard procedures to address likely shifts in personality, values, and identity following psychedelic experiences, which has been proposed as a more appropriate standard for psychedelic experiences (Lee et al., 2024).
Preparatory sessions should provide the strongest available evidence-informed protective measures. Adequately trained therapists should provide psychoeducation before the session, using protocols related to substance effects, efforts to strengthen the therapeutic alliance, and the establishment of clear behavioral and psychological intentions for the session (Wolff et al., 2025).
2. Dosing (during the session)
During sessions, therapists should use neutral, non-evaluative language and avoid terminology loaded with subcultural or evaluative overtones that could unconsciously direct clients’ experiences. Mindful communication among all therapeutic team members present is equally important, as any verbal or nonverbal exchange in the clients’ presence forms part of the therapeutic “setting.”
Therapists who engage in self-examination and introspection are better equipped to recognize personal preconceptions—including philosophical or religious inclinations—and consciously bracket them to avoid subtly steering clients during vulnerable moments. One potential protective measure is allowing the client to have a trusted individual of their choosing present throughout the session, serving as both a source of emotional support and an observer of the therapist’s behavior (Villiger, 2025).
3. Integration (after the session)
Given the clients’ suggestible state, therapists should remain aware throughout the integration process of the potential impact of their own beliefs. This involves exercising humility both in understanding the client’s condition and in refraining from imposing a metaphysical perspective (conceptual, mental, spiritual, intellectual, or speculative).
A good way to support integration is to review clients’ original intentions for the psychedelic experience, ascertain which integration practices are most relevant, commit to regular integration practices, identify relationships and communities that can support integration, and create or find physical spaces at home, public spaces, or in nature that support the ongoing unfolding of psychedelic experiences over time (Bathje et al., 2022). Therapists’ supervision can ensure adequate integration by preventing harm and consolidating gains (Caporuscio et al., 2025).
What Therapists Who Practice Psychedelic-Assisted Therapy Must Keep in Mind
Research on PAT continues to show encouraging results, particularly in its ability to break down entrenched thought patterns and open individuals up to new ways of thinking and feeling. That said, this very openness has a downside: It can leave people more susceptible to external influence than they otherwise would be.
This is precisely why the ethical stakes in this field are so high. Therapists working with PAT must go beyond standard practice by securing enhanced informed consent, holding firm professional boundaries, and committing to specialized training and regular supervision—not as bureaucratic checkboxes, but as genuine safeguards for the people in their care.
