Background <p> Psychedelic-assisted therapy (PAT) is gaining recognition as a promising intervention for treatment-refractory mental health conditions in adults. While interest in its applications for adolescents is growing, critical gaps remain in understanding safe and effective delivery of PAT to this vulnerable population, including implications for caregiver/family (used interchangeably) involvement in the intervention. Caregivers play a crucial role in adolescent mental health treatment by supporting recovery and disrupting illness-maintaining patterns. They also benefit from resources to navigate the challenges of caregiving. This review synthesizes existing literature on evidence-based adolescent mental health treatments, best practices in PAT delivery, and family systems theory to propose a framework for integrating caregivers in adolescent PAT.</p> Conclusion <p>Current literature in both PAT and adolescent mental health provides a compelling case for the direct involvement of caregivers in PAT for adolescent populations. In modern PAT, therapeutic setting (i.e., “set and setting”) is increasingly recognized as essential for optimizing outcomes. Similarly, the family system serves as a critical setting that may shape PAT efficacy in adolescents. This review provides recommendations and unique considerations for the incorporation of caregivers into PAT protocols for adolescents to maximize safety and efficacy of the intervention.</p>