Psychedelic drugs like psilocybin, LSD, MDMA, and ketamine, among others, can radically alter mood, behaviour, emotions, thoughts, sense-perception, and consciousness. Participants who take psychedelics in a therapeutic context may be vulnerable to sexual violence, patient abuse, and therapist misconduct in different ways than in “ordinary” psychotherapeutic settings. In one prominent and tragic case, a MDMA-assisted therapy participant filed an ethics complaint and civil court claim, attesting to sexual assault by her therapist over a two-year period beginning at the time of her treatment for post-traumatic stress disorder. The investigation of her case included reviewing available video recordings of sessions, which revealed disturbing therapist misconduct during therapy sessions and added credibility to her allegations of sexual violence. Later, some of these video recordings were consensually shared with journalists and published. These videos played an important role in uncovering the ethical violations, which resulted in both of her therapists being barred from participation in future clinical trials, as well as institutional reviews of psychedelic therapy ethics guidelines and safety policies.
In light of worrisome instances of malpractice and abuse, practitioners in the field of psychedelic-assisted therapy have been doubly concerned with ensuring patient safety, therapist accountability, and institutional ethical integrity. Today, clinical research involving psychedelic drugs often mandates the video recording of psychedelic-assisted therapy sessions, with some exceptions.
From a patient perspective, video recording technology can have significant benefits for safety. Video recording generates tangible documentation that can solidify ethical and legal accountability in cases of malpractice, abuse of power, negligence, sexual assault, and other unethical behaviour by therapists. Awareness of external observation may also help deter reckless, inappropriate, or violent behaviour in therapy sessions. Video recordings can also have important benefits for patient reflection; for example, videos may allow patients to understand the effects of psychedelic drugs on them, to revisit and engage with episodes from their drug experiences, and to recall experiences that may be forgotten or remembered differently due to psychedelic effects on memory and perception. However, revisiting sessions through video recordings also generates the risk of reliving challenging or traumatic experiences.
From a practitioner’s perspective, recordings can allow therapists to revisit sessions with incomplete notes, reduce memory-related biases, and further develop patient-specific healing strategies. This can be particularly helpful for therapists participating in lengthy psychedelic-assisted therapy sessions, while maintaining many complex patient relationships. When consented to by patients, video recordings can be used by clinical supervisors and educational institutions as part of professional training, which can improve quality of care and attention to detail in real-world situations. Analysis of audio and video data can also be useful within quantitative and qualitative research in the rapidly growing field of psychedelic-assisted therapy.
However, as in all areas of mental health practice, video recording technology poses significant ethical concerns related to privacy, data security, and informed consent. Psychedelic-assisted therapy involves highly sensitive and confidential interactions, and privacy matters deeply. Video recordings capture intimate details about therapy sessions and drug experiences at a far higher level of detail and precision than is possible with written notes or audio recordings. Even with strict data security protocols for medical records, data insecurity is a real risk, whether it occurs through human error, abuse of power, technological malfunction, or hacking. If video recordings are misused, shared without consent, or leaked for any reason, there can be significant negative consequences for the patient. Patients are justified in questioning how their information, experiences, emotions, and behaviour within the therapeutic space will be kept confidential and secure.
Video recording can also reduce patient trust in therapist-patient confidentiality and hinder open communication. For example, patients may be less likely to share intimate details about themselves or others, discuss illegal activities such as illicit drug use, or discuss other sensitive or stigmatized topics while being recorded. Hesitancy to share any relevant details or events can alter the therapist-patient dynamic and negatively affect healing outcomes.
The presence of cameras can also change the nature of the psychedelic setting and healing space. Psychedelic healing practices typically arrange physical environments and symbolic spaces that emphasize disconnection from digital technology and deepening connection with nature and the universe. Practices often involve spirituality, meditation, mindfulness, religiosity, mysticism, art, and/or music as part of the healing process and therapeutic technique. Within many cultures and healing traditions, psychedelic substances and spaces are considered sacred and spiritually endowed. Cameras could ultimately be disruptive to these psychedelic spaces and healing techniques in intangible and measurable ways. Furthermore, psychedelic drugs can amplify or intensify emotional experiences and acute anxiety. Thus, awareness of a camera could exacerbate common psychedelic side effects related to fear, anxiety, and paranoia.
All people deserve access to psychedelic healing spaces that make them feel safe and comfortable enough to fully participate in the practice. It is reasonable and justified for prospective participants to decline video recording after weighing the significant risks and benefits. Thus, it is ultimately coercive to mandate video recording – patients should have a genuine option to opt-out without losing access to the therapy. Video recording technology should only constitute part of a holistic structure of safeguards and accountability. Even when consensually used, recording technology can fail or be actively manipulated by abusers. Thus, psychedelic-assisted therapy cannot rely solely on video recording as an ethical crutch. Just as in conventional psychotherapy sessions, which are often not recorded, institutions must develop layered safeguards and ensure ethical accountability in other important ways.
Clinicians and researchers tasked with discussing informed consent in psychedelic-assisted therapy must validate concerns with video recording technology and center participant autonomy. Participants also deserve to have distinct informed consent processes for different possible uses of video recordings. In particular, it is ethically important to distinguish between consent to video recording for treatment purposes, training purposes, and research purposes. Separating these different cases allows for more nuanced dialogue about the risks and benefits for participants and help them understand the background interests of clinical, educational, and research institutions.
A focus on creating a safe and comfortable setting that is attuned to the participant’s individual needs and background is critical; without this approach, therapists risk delivering ineffective therapy and amplifying harmful dynamics with participants in vulnerable situations. Institutions that take on the enormous ethical responsibility of guiding psychedelic experiences should never coerce participants or clinicians into participating in technological practices that do not make them feel safe, secure, or comfortable. If a patient decides to decline video recording, they still deserve full access to psychedelic-assisted interventions that could substantively improve their symptoms, holistic mental health, and quality of life.
This piece was adapted from “The “Third” Eye: Ethics of Video Recording in the Context of Psychedelic-Assisted Therapy” published in the December 2023 issue of the Canadian Journal of Bioethics. The full article is available for download as a free open-source publication here.
Khaleel Rajwani, M.A. is a SSHRC Doctoral Fellow with the Department of Philosophy at McGill University.