Part 4: The role of the female facilitator and the importance of female facilitation
In the final part of our four-part blog series, ‘Understanding the attitudes, experiences, and needs of women who attend psychedelic retreats,’ we explore how women’s experiences may be influenced by the sex of their retreat facilitator. We examine recent research which has investigated women’s preferences toward same-sex psychedelic-assisted therapy practitioners in the clinical setting, asking how these findings could be translated to the retreat setting. We then examine how retreat facilitators could better cater to the needs of their female retreat participants, drawing on the experiences of psychedelic retreat facilitator, Mary Bonnet.
A key theme that emerged from our pilot survey (‘Understanding the attitudes, experiences, and needs of women who attend psychedelic retreats’), conducted in collaboration with Beckley Retreats, was the importance of having a female facilitator. Respondents consistently rated having women facilitating the retreat as more important in the Post-Retreat Survey compared to in the Pre-Retreat Survey. Importance ratings on this question increased 22.34% Pre- to Post-Retreat, with a mean importance rating of 92.67% Post-Retreat. This suggests that women with no prior retreat experience (all of our respondents were psychedelic-retreat-naive) did not initially consider having women facilitating their retreat important, but that the retreat experience consolidated the importance of this option. Our pilot survey did not ask respondents about the sex of their facilitator, so further research is needed to explore whether this increase reflects participants’ positive experiences with a female facilitator or their perception that the retreat would have been enhanced by having a female facilitator.
Our Survey, now live on our website and open to women who plan to attend any psychedelic retreat program, aims to gain further insight into the experiences of women within the psychedelic retreat setting, including their experiences with same- and different-sex facilitators. Amongst other objectives, we hope that findings from our Survey will guide the development of retreat offerings specifically designed around women’s needs in these spaces.
Participant preferences toward practitioner sex
To our knowledge, no research has specifically and systematically focused on understanding how facilitator sex may influence women’s attitudes, experiences, and needs within the psychedelic retreat setting. Findings from our Survey will therefore offer important insights into these influences. However, recent research has investigated client preferences toward the demographic characteristics - including sex - of their psychedelic-assisted therapy practitioner(s) in the clinical setting (1).
Historically, the majority of psychedelic-assisted psychotherapy trials have tended to use male-female co-therapist teams, consisting of one cisgender man and one cisgender woman (2). This practice originated from early psychedelic practitioners and researchers such as Christina and Sanislav Grof (2). The rationale for continuing this practice in more recent psychedelic-assisted psychotherapy trials is the idea that a male-female co-therapy team can contribute positively to a participant’s sense of safety (2); however, there is limited empirical evidence to support this claim, and even evidence suggesting that this practice can contribute to compromised participant safety (3). Moreover, this practice has been highlighted as problematic since it is based on essentialist notions of gender (2, 4) that exclude non-binary or transgender practitioners and, consequently, also non-binary or transgender clients who seek practitioners with shared experiences (2).
Hence, investigations into participant preferences toward the sex of their psychedelic-assisted therapy practitioner(s) (as well as how these relate to relevant outcomes) are needed to inform new, evidence-based best practices for optimal practitioner-participant allocation in psychedelic-assisted therapy settings. It is conceivable that preferences toward practitioner sex (and whether or not these preferences are accommodated; 2) may affect important aspects of psychedelic-assisted therapy such as the acute psychedelic experience, sense of safety, and therapeutic alliance. These effects are also relevant in the psychedelic retreat setting.
In a study by Olivia et al. (2024), participants (n = 635) indicating depressive symptoms were asked to rate the importance of several practitioner characteristics, including having a practitioner who is the same-sex or the same-race, for both cognitive behavioural therapy and psychedelic-assisted therapy (1). Results revealed a significant effect of participant sex on the importance assigned to having a same-sex practitioner across both therapy types, with women assigning more importance to having a same-sex practitioner than men (F(1, 623) = 20,019, p < .001) (1). These results are consistent with previous psychotherapy research by Pikus and Heavy (1996), which found that female clients expressed a preference for a female psychotherapist and male clients either expressed no preference or a preference for a female psychotherapist (5).
Future research should investigate why women assign more importance to having a same-sex practitioner than men. One possible explanation is that, ‘A gender match might alleviate some fear of sexual or other abuse during therapy in the face of documented abuse in clinical trials’ (3). There is an inherent power asymmetry between practitioner and participant in psychedelic-assisted therapy settings (on account of altered relational dynamics, compromised informed consent, psychedelics’ subjective effects; see Part 2) which can be (and sadly has been) exploited by bad actors. Most documented exploitation has been against women (6), offering a potential explanation for the relatively greater importance assigned to having a same-sex practitioner by female versus male participants (1).
Results from Olivia et al. (2024) revealed that participants’ race also affected the importance assigned to having a same-sex practitioner across both therapy types, with racial and ethnic minority participants assigning more importance to having a same-sex practitioner than non-racial and ethnic minority groups (F(1,623) = 14.392, p < .001) (1). This result highlights the importance of intersectionality when considering client preferences (7). As PettyJohn et al. (2020) propose, relational intersectionality resulting from similarities or differences in therapist and client identities has the potential to impact therapeutic alliance, with shared intersectional identities potentially improving therapeutic alliance (8). The need for shared intersectional identities thus also highlights the importance of increasing minority representation at the practitioner level (7).
Interestingly, all participants, regardless of sex or race, assigned significantly more importance to having a same-sex CBT practitioner than to having a same-sex PAT practitioner (F(1,623) = 10.202, p = .001) (1). The authors offer the following explanation for this finding, ‘Psychedelic experiences, being intrapersonal by nature, could lead clients to assign greater value to a practitioner’s experience over demographic factors like gender’ (1). This is consistent with other research indicating that, in the context of psychedelic-assisted therapy, practitioner sex is rated as relatively less important than other practitioner characteristics by participants (2, 9). For example, reflecting on their experiences as female PAT (MDMA-assisted therapy) practitioners in same-sex therapist teams, Wagner et al. (2019) describe that, ‘Rather [than therapist sex], what participants appeared to be interested in (from comments and conversation) was the respective expertise of each of the therapists, and participants would often ask each of us about either our MDMA or CBCT work’ (2).
However, these explanations ignore the influence of practitioner sex on the interpersonal dimensions of psychedelic use (present, although differentially, in both psychedelic-assisted therapy and psychedelic retreat settings) explored in Part 3. For instance, in his description of his own experiences of MDMA-assisted therapy, Ching (2020) describes the significant impact of practitioner sex on the interpersonal dimensions (and resultant therapeutic outcomes) of his experience:
‘In fact, I believe that the male-female, husband-wife, parental figure-like composition of the therapy team facilitated a highly compassionate, candid, and ultimately, corrective interaction in regard to the discussion of my sexuality (I write this in recognition of queer critiques of the hegemonic nature of heteronormative families).’ (7)
As the author goes on to acknowledge, preferences toward practitioner sex will vary between individuals on account of multiple variables including gender, sexuality, and previous experiences with psychedelics/therapy/trauma (7). We must adopt a patient-centric, individualised approach to accommodating and understanding participant preferences toward practitioner sex (4).
Accommodating women’s preferences for a same-sex practitioner in the psychedelic retreat setting
As already discussed, to our knowledge, our Survey is the first to specifically and systematically focus on understanding how facilitator sex may influence women’s attitudes, experiences, and needs in the psychedelic retreat setting. For now, then, our understanding of these influences in this specific setting is more limited. However, it is conceivable that client preferences toward practitioner sex in the psychedelic retreat setting will closely reflect participant preferences in the psychedelic-assisted therapy setting, since, despite some important differences, both settings share a need for a client/participant-practitioner relationship premised on safety and trust.
Hence, extrapolating from Olivia et al. (2024), it could be that female retreat participants exhibit a stronger preference for a same-sex practitioner than male retreat participants (1). Indeed, voices from within the psychedelic retreat industry seem to share a belief in the need for women-only retreats that are facilitated by women-only. Female facilitators emphasise ‘embodied knowing,’, i.e., using their own lived experiences as women to consciously create these intentional, safe, women-only spaces. In our conversation with psychedelic retreat facilitator, Mary Bonnet, she explained how embodied knowing influences her facilitation:
‘In women-only spaces, I relax more quickly - I guess because there’s an embodied knowing of how I would want the space to be - it’s innate. Whereas in mixed-sex spaces, I’m much more alert - looking at safety, looking at the nervous systems of people in the group, looking at women who may be activated by what a man has just said.’
Mary also noted that the absence of this embodied knowing in male facilitators can comprise women’s sense of safety:
‘Safety is a primary aspect of women’s specific needs in psychedelic retreats, and it depends on whether the facilitators are all women. I think having an all women team is important - if not, then having sensitive men on the team is important. [...] A complete lack of awareness and sensitivity from male facilitators is typically what goes wrong in terms of providing safe spaces for women.’
In conclusion, early findings indicate that women need and want women-only psychedelic retreat offerings that are facilitated by women-only. Here, we have explored recent research which has investigated women’s preferences toward same-sex practitioners in the clinical setting, asking how these findings could be translated to the retreat setting. We have also drawn on the experiences of psychedelic retreat facilitator, Mary Bonnet, to discuss the importance of accommodating women’s preferences for a same-sex practitioner in the retreat setting.
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References
Oliva, A. B., Earleywine, M., Low, F., Altman, B. R., & De Leo, J. A. (2024). Client treatment preferences in psychedelic-assisted therapy for depression in participants with depressive symptoms. Journal of Psychedelic Studies (published online ahead of print 2024). https://doi.org/10.1556/2054.2024.00334
Wagner, A., Mithoefer, A., & Monsoon, C. (2019). Breaking the Mold: Reflecting on Our Experiences in Same-Gender Therapist Teams with MDMA-Assisted Psychotherapy, MAPS Bulletin Special Edition Spring 2019, 29(1). https://maps.org/news/bulletin/breaking-the-mold-reflecting-on-our-experiences-in-same-gender-therapist-teams-with-mdma-assisted-psychotherapy-spring-2019/
McNamee, S., Devenot, N., & Buisson, M. (2023). Studying Harms Is Key to Improving Psychedelic-Assisted Therapy-Participants Call for Changes to Research Landscape. JAMA psychiatry, 80(5), 411-412. https://doi.org/10.1001/jamapsychiatry.2023.0099
Belser, A. (2019). How privilege affects gender inclusivity in psychotherapy. [Audio podcast]. Psychedelics Today. https://psychedelicstoday.com/2019/06/18/dr-alexander-belser-how-privilege-affects-gender-inclusivity-in-psychotherapy/
Pikus, C. F., & Heavey, C. L. (1996). Client preferences for therapist gender. Journal of College Student Psychotherapy, 10(4), 35–43. https://doi.org/10.1300/J035v10n04_05.
Ross, L. K., & Nickles, D. (Hosts). (2021-2022). Cover Story: Power Trip. [Audio podcast]. VoxMedia. https://podcasts.voxmedia.com/show/cover-story-power-trip
Ching, T. H. W. (2020). Intersectional insights from an MDMA-assisted psychotherapy training trial: An open letter to racial/ethnic and sexual/gender minorities. Journal of Psychedelic Studies, 4(1), 61–68. https://doi.org/10.1556/2054.2019.017
PettyJohn, M. E., Tseng, C. F., & Blow, A. J. (2020). Therapeutic Utility of Discussing Therapist/Client Intersectionality in Treatment: When and How?. Family process, 59(2), 313–327. https://doi.org/10.1111/famp.12471
Earleywine, M., Low, F., Altman, B. R., & De Leo, J. (2022). How Important Is a Guide Who Has Taken Psilocybin in Psilocybin-Assisted Therapy for Depression? Journal of Psychoactive Drugs, 55(1), 51–61. https://doi.org/10.1080/02791072.2022.2047842