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Psychedelic-Assisted Therapy Isn’t Easy: Setting Expectations For Curious Patients

Psychedelic-Assisted Therapy Isn’t Easy: Setting Expectations For Curious Patients

In psychedelic-assisted therapy, we often talk about “set and setting“. This is one’s mindset going into a psychedelic experience (set), and the environment where the experience takes place (setting).

But set and setting also point to someone’s mindset prior to a psychedelic experience. Therefore, the “set and setting” also relate to setting expectations.

The “priming effect” is a popular concept in the field of psychology. It describes how exposure to a stimulus has a significant influence — consciously or unconsciously — on beliefs and behaviors. From my experiences in psychedelic-assisted therapy, the psychedelic renaissance from the media seems to be having a priming effect on expectations for psychedelic journeys. This comes from my decades in the field of research and studying psychedelics.

Dr. Rick Barnett
Courtesy of Dr. Rick Barnett

Examples From My Own Experiences

One colleague, in eager anticipation of a psychedelic experience simply stated, “I just feel like my brain needs a reset.”

Another example is from a recent ketamine patient. After doing significant research on ketamine and other psychedelic-assisted therapies, he/she was disappointed in the results of their ketamine experience. Why? They expected, but did not receive, an encounter with the divine — “or at least some form of awakening or enlightenment.”

One person I recently spoke with expressed disappointment following an MDMA clinical trial. While the experience itself was profoundly healing at the time, there was no follow up from researchers after the trial ended. The patient’s PTSD symptoms re-emerged one year later. 

What Makes Psychedelic-Assisted Therapy Different?

Psychedelic-assisted therapy is not a panacea. It is a tool among tools, albeit a very different and sometimes profoundly impactful tool among tools. Still, psychedelic-assisted therapy differs from other therapies in many ways. One of the most prominent? The drug and the set and setting in which it is delivered or experienced are often subjectively indistinguishable.

Let’s break that down a little. 

In psychedelic-assisted therapy, we talk a lot about preparation and integration. A major part of my work related to psychedelic therapy is being intentional about exploring one’s expectations. Likewise, we must explore their imagined post-dosing integration work. This is something I like to call “pre-integration.” 

How do I define pre-integration? It simply refers to asking patients a simple question: How do they imagine their lives to be the same or different in the days, weeks, months and even years after a psychedelic experience.?

How To Prepare For Psychedelic-Assisted Therapy

Preparing someone for the dosing session must include open and honest discussion around the experience. Explaining the full range of what is possible is important.

On one end of the spectrum, the experience may yield mild effects. This may leave a person wondering what all the hype is about.

On the contrary, some patients may experience an authentic connection with the divine. This may lead to a life-changing awakening, and a new understandings that was previously inconceivable to the individual. 

Many patients whom I work with report a marked difference between what they expect and what actually occurs. This is true whether I’m acting as a guide or coach, related to preparation, pre-integration, and integration in ketamine-based psychotherapy.

One must examine many factors that may play a role in the “priming effect” relating to psychedelic-assisted therapy. For practitioners and patients alike, this is a major area of improvement. 

Dr. Rick Barnett

View all posts by Dr. Rick Barnett

Dr. Rick Barnett is a licensed psychologist-doctorate, licensed alcohol and drug counselor with an additional Master’s Degree in Clinical Psychopharmacology.

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