From Tune in, Turn On, Drop Out to Not Eligible, Not Retained, Not Returning, Endings Exits and Ethical Edges in Psychedelic Therapy Today

Abstract

Not Eligible: Patients screened-out before treatment begins.

Not Retained: Patients who begin the process but disengage, drop-out, or are withdrawn.

Not Returning: Patients who end therapy abruptly or complete it in unexpected ways.

Each of these outcomes reflects not just logistical or clinical hurdles, but deeper questions around relational rupture, boundary setting, integration failures, and the limits of what this modality can hold.

At times, exits are also prompted by significant adverse events, such as psychological destabilization, resurfacing trauma, or physiological concerns, which require swift clinical judgment and ethical containment.

What does it mean to “end well” in psychedelic care? How do we accompany people across thresholds, even when they lead away from the medicine? Whether due to relational rupture, lack of readiness, or significant adverse events, the therapist’s role is not just to facilitate, but to hold, and sometimes to let go, with care.

Biography

Dr Julia King Olivier is a Swiss FMH-certified psychiatrist and psychotherapist with dual specializations in adult and child psychiatry. Founder of the Compassionate Care Center in Geneva, she offers integrative, legal psychedelic-assisted therapy. A CIIS and MAPS-certified practitioner, she has developed coursework for Fluence, Mind Medicine Australia, and mentored the most recent cohort of the CIIS-CPTR program. Julia co-developed the course Poetry, Symbol & Story for Psychedelic-Assisted Therapy and supports MAPS trainings globally. A founding member of the Swiss Society for Psychedelic Medicine, she is committed to advancing safe, holistic care. Outside of work, she swims year-round in Lake Geneva and practices the Wim Hof Method.