When the Therapist Feels Caught Off Guard
Why all therapists need supervision and consultation.
Posted October 28, 2025 | Reviewed by Margaret Foley
I was consulting with a psychologist recently about a moment that arose in one of her medicine sessions. She described:
“We had talked about touch before the session. We had practiced holding hands, and we discussed that touch would always remain nonsexual. But then, during the ketamine session, he began slowly squeezing my arm. It felt uncomfortable. It felt intimate. It caught me completely off guard.”
These are the kinds of moments that haven’t yet reached textbooks.
Even for seasoned clinicians, moments like this—when a client’s behavior suddenly feels confusing, charged, or outside the bounds of what we expected—can leave us disoriented. In psychedelic-assisted therapy, where boundaries are softened and emotions are raw and deep, these experiences can be even more complex.
This is why therapists need supervision and consultation: ongoing, deliberate, structured spaces for reflection and support, no matter how many ethics courses we have taken or how many years we have practiced.
The Human in the Therapist
Supervision is not just for trainees. Research has consistently shown that even experienced therapists benefit from consultation in improving clinical judgment, ethical decision-making , and emotional resilience .
When we enter the therapy room, especially the psychedelic therapy room, we bring not only our training but our humanity. We bring our nervous systems, our histories, our blind spots, and our vulnerabilities.
In psychedelic-assisted therapy, this human complexity is amplified. States of expanded consciousness can blur interpersonal boundaries, activate transference and countertransference in powerful ways, and evoke attachment experiences.
When a client reaches out and touches us, or when touch suddenly feels sexualized, it can stir our own internal alarms:
These are not questions to navigate alone.
Supervision as a Container for the Therapist’s Experience
Clinical supervision offers a container for the therapist’s process. It is a structured relationship designed to help therapists reflect on what happened in the room, what was felt, and what it might mean without judgment.
In psychedelic-assisted psychotherapy , where therapists are often exploring new relational and somatic terrain, the need for this kind of reflective space is even more crucial. Supervision helps us:
A Practice of Lifelong Supervision
Seeking supervision is a sign of maturity.
Regardless of our clinical expertise, we will still encounter moments that challenge our conceptualizations, trigger our vulnerabilities, and evoke discomfort or unease. It is especially true in psychedelic-assisted work. No matter how seasoned we are, we cannot hold others in their vulnerability without also being held in ours.
So, when you find yourself in a moment that feels charged, uncertain, or outside the map, remember that you are not alone. Other therapists are encountering similar challenges and are eager to offer support, reflection, and connection—just as they, too, need yours.
So what happened with the therapist I was consulting with? We discussed how to gently, kindly, and firmly hold boundaries with the client, both for her sake and for the client's. Clients rely on us to keep them safe during moments of vulnerability, including sometimes keeping them safe from their own altered decisions. It's this safety that allows them to truly let go into a psychedelic journey. So we practiced how to move a client's hand out of touch that feels misaligned with agreements and intentions and back into touch that is warm, compassionate, and boundaried: wordlessly moving the client's hand from the therapist's arm back to her hand and allowing him to squeeze her hand.
Perhaps you would have done the same, or perhaps you would have made a different choice. Either way, consultation allows us to come to therapeutic decisions that are in line with both our values and the clients' needs.
Because healing and growing, both for clients and for us, happen within supportive relationships.
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Chandra Khalifian, Ph.D., and Kayla Knopp, Ph.D., are clinical psychologists, researchers, and educators who specialize in diverse, expansive relationships, and psychedelic-assisted relationship therapy.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.