Troubleshooting Treatment: How Experienced Guides Handle Client Issues
We know no treatment is entirely without side effects. How do experienced guides handle client issues when they arise?
Depending on the treatment, clients can experience a range of issues.
Ketamine, despite being considered broadly safe, can cause dizziness and blurred vision. Psilocybin mushrooms are known for nausea. And even transcranial magnetic stimulation therapy (TMS therapy), which generally has minimal side effects, can cause headaches, tingling, and scalp discomfort.
The knowledgeable and compassionate handling of these issues by experienced guides can be the difference between an unpleasant or healing experience. At the same time though, even “bad trips” often offer valuable experiences—with 84 percent of one study’s participants saying they benefited from their challenging trips.
When clients encounter difficult experiences, do experienced facilitators fix the issue or let it play out? Is there a balance to be struck? And is there anything you, the client, can do in preparation to prevent some of the more common issues?
To help us understand how psychedelic professionals troubleshoot treatment and support their clients, we talked to practitioners from around the world about the practices they use in their clinics and retreats. Here’s what they had to say.
Andrew Tansil – Sayulita Wellness Mushroom Retreat
At Sayulita Wellness Retreat, our experienced guides are adept at handling a range of client issues that may arise during treatment, such as nausea or increased heart rate. Our approach is to strike a balance between intervening when necessary and allowing natural processes to unfold. For instance, if a client experiences nausea during a psychedelic therapy session, we may offer ginger tea as a natural remedy, while also providing emotional support and reassurance. We believe in the body’s innate wisdom and encourage clients to breathe through and observe their experiences, rather than immediately trying to ‘fix’ them. These issues, while not uncommon, vary greatly among individuals. We prepare clients by advising dietary adjustments and mental readiness techniques prior to treatment. This proactive approach, combined with our skilled facilitation, ensures each client’s journey is as smooth and transformative as possible.
— Andrew Tansil, Sayulita Wellness
Victoria, RN, BSN – Ketamine Clinics Los Angeles
Ketamine infusions can induce anxiety in many patients, especially those who are new to the psychedelic experience. Infusion nurses play a crucial role in managing anxiety in patients undergoing ketamine treatments. As a nurse, educating patients before the infusion is fundamental. We take time to inform patients about the continuous monitoring during the infusion of their vitals and direct observation by the medical team, ensuring safety and comfort. During the infusion, grounding techniques are essential to maintain calmness, such as deep breathing exercises, which help in regulating anxiety. Additionally, we encourage patients to lift their eye mask or focus on tangible sensations like the pressure of the blood pressure cuff, aiding in anchoring their awareness and reducing feelings of disorientation when needed. If a patient begins to panic, the presence of a nurse becomes invaluable. We nurses can offer direct emotional support, such as holding the patient’s hand and providing a reassuring presence. If anxiety intensifies, nurses are equipped to administer anxiety medications, adjust the ketamine dosage, or even pause the infusion temporarily. These measures aim to re-establish a sense of control and comfort for the patient, ensuring a safer and more positive treatment experience.
— Victoria, RN, BSN, with Ketamine Clinics Los Angeles
Charles Martinez, FNP-BC – Stella Center DC
While these symptoms are infrequent, the most common short-term physical side effects we observe post treatment include dizziness and nausea. Stella advises patients to fast for a minimum of 4 hours leading up to an IV ketamine session. Before treatment, we administer an anti-nausea medication and if a patient declines, we can offer an oral ginger supplement. To prevent side effects such as dizziness and nausea, patients are encouraged to keep their eye masks on until fully grounded after the experience. This precaution is crucial due to ketamine-related nystagmus, which may contribute to dizziness and nausea if patients attempt to focus prematurely. All of our ketamine treatments are medically monitored and dose controlled, allowing us to treat any unpleasant side effects in real time.
— Charles Martinez, FNP-BC, Clinic Director of Stella Center DC
Dr. James Simonson – Integrative Psychiatry of Oklahoma
Ketamine, a powerful anesthetic, has demonstrated efficacy in helping patients navigate a host of mental health challenges. However, its administration comes with cardiovascular, respiratory, and consciousness implications. As an anesthesiologist trained to manage the physiologic changes during the administration of the anesthetic ketamine, I recognize the importance of understanding and addressing potential side effects. At our facility, all patients are closely monitored with ASA safety monitors from the start of their treatment until they regain waking consciousness. I work one-on-one with patients, providing continuous support and am always available to address any side effects that may arise. This includes helping them through challenging experiences and managing fast heart rates or high blood pressures that often occur as a result of ketamine administration.
Moreover, employing proactive measures such as pretreatment with anti-nausea medications and utilizing infusions, which allow us to anticipate and address potential side effects. This includes the ability to slow the rate of administration if and when side effects occur. Navigating through challenges like nausea, muscle spasms, or tingling, we prioritize personalized care to guide individuals towards well-being with confidence and expertise.
— Dr. James Simonson, MD, Owner and Founder of Integrative Psychiatry of Oklahoma
Dr. Nathan T. Gilmore – Anew Therapy
At Anew Therapy, we pride ourselves on having an experienced team of medical professionals who are well-versed in handling any patient scenario. This includes situations where a patient may experience uncomfortable but common symptoms during or after their ketamine therapy session, such as nausea, dizziness, and headaches. Our team takes preventative steps to address these potential side effects by closely monitoring each patient during their treatment and providing them with personalized care. This can include adjusting the dosage of ketamine, offering anti-nausea medication, and providing a calm and supportive environment for the patient to relax in. We also take the time to educate our patients on what to expect during and after their therapy session, as well as how to manage any discomfort they may experience. By taking these proactive measures, we strive to ensure that every patient has a positive and comfortable experience with ketamine therapy.
— Dr. Nathan T. Gilmore, M.D., Anew Therapy Medical Director
Dr. Owen Scott Muir – Fermata
In the context of providing interventional care, patients can have a variety of experiences. Even with something that involves no pharmacological care whatsoever—like transcranial magnetic stimulation—seizures are rare but possible. The more you are familiar with common medical syndromes, like syncope, and can explain appropriate next steps, the more the patient will be reassured. Staying calm, and knowing the next steps—even if that’s just calling 911 for EMS—will put everyone at ease.
— Dr. Owen Scott Muir, M.D., Co-Founder of Fermata Health
How Clients Can Prepare for Treatment
While some issues are more common than others with psychedelic treatment, many of the more common ones can be prevented with basic preparation—both mentally and physically. Fasting and diet management can help prevent nausea, while practices like setting intentions can help prevent anxiety.
High-quality treatment providers will know how to support you before, during, and after your treatment. Their support will help prevent issues and ensure you have the smoothest experience possible. When administered in a controlled environment with experienced guides, psychedelic treatment can be safe and incredibly transformative.
