Strong Alliance, Weak Conclusions: Comment on Goodwin et al. (2026) “The Role of Therapeutic Alliance in Psilocybin Treatment for Treatment-Resistant Depression”

Abstract

This commentary critically examines the interpretation and analytic choices in Goodwin and colleagues’ recent analysis of therapeutic alliance in psilocybin treatment for treatment-resistant depression. While the authors conclude that alliance did not meaningfully contribute to treatment efficacy, we argue that this interpretation is not supported by the reported results, which are, in addition, shaped by methodological decisions that obscure relevant effects. By contextualizing the observed associations, clarifying the logic of mediation analysis, and pointing out methodological weaknesses, we show that the available evidence is more consistent with a meaningful role of therapeutic alliance in shaping both the psychedelic experience and clinical outcomes. Furthermore, we highlight unexplained deviations from the study protocol that warrant scrutiny. These concerns underscore the importance of accurately characterizing psychological and contextual factors in psychedelic treatment research and call for more comprehensive and transparent analyses of psychotherapeutic processes.