In many ways, a psychedelic therapy session is similar to conventional therapy: You meet with a therapist, discuss situations going on in your life, and explore various coping strategies. The difference, of course, is that you also take a psychedelic drug as part of the therapeutic process.

Therapy is for everyone, not just people dealing with a traumatic event or severe emotional disturbances. However, psychedelic-assisted therapy is a little different because it’s typically reserved for people who have a history of a specific condition, such as depression, post-traumatic stress disorder (PTSD), or substance abuse.

If you’re considering psychedelic-assisted therapy, the following therapy session questions can help clarify your mindset, ensure you have the answers you need to prepare, and better understand what to expect from your session.

Questions to Ask Yourself Before A Psychedelic Session

Why do I want to pursue psychedelic therapy?

Psychedelic-assisted therapy is not a magic bullet. If only things were that simple, right? Instead, psychedelic therapy is a tool in your wellness toolkit. You’ll still have internal work to do after the session.

Asking yourself why you want to pursue this form of therapy can help clarify your goals.

  • Did a medical professional recommend psychedelic therapy because other treatment options haven’t worked?
  • Are you interested in alternative treatments and want to sign up for a clinical trial?
  • Did a friend succeed with psychedelic-assisted therapy, and you’re expecting similar results? (Heads up: Your experience will vary, and that’s okay.)
  • Do you want a quick fix or a fun trip? If so, psychedelic therapy might not be suitable for you.

Am I familiar with the psychedelic that I will take?

Before your first therapy session, make sure you know what you’re taking, how much, and what you can expect from the trip.

In the United States, ketamine is available by prescription only. If you’ve signed up for a psychedelic clinical trial, you might take a psychedelic such as MDMA or psilocybin, or you may take a placebo.

In any of these instances, you should feel comfortable asking the mental health professional or research team questions about the drugs and how they might make you feel.

Am I ready for this experience?

This is a big question, but it’s an important one. The insights you gain from psychedelics can be illuminating. They can also be challenging. You might relive old traumas, unearth forgotten memories, and feel a negative outburst of emotion, all in the same session.

Karo Munay is a facilitator at Aya Healing Retreats in Peru. Rather than rushing into a psychedelic experience, Munay suggested that people prioritize patience and critical thinking because “sometimes the desire to go through an experience or a ceremony can make people make wrong decisions,” she said.

An experienced therapist should be able to help you determine whether or not you’re ready for psychedelic therapy, but this is also a vital question to ask yourself. If you don’t feel like you’re emotionally prepared to deal with hard truths or difficult conversations, it’s okay to wait.

Do I feel comfortable with this therapist?

It’s essential to make sure that you feel connected to your therapist, who will play a critical role in helping you work through any positive or negative insights. Just as you should be a good fit for psychedelic-assisted therapy, your therapist should also be a good fit for you.

Munay waited two years before her first ayahuasca ceremony because she wanted to find someone who made her feel comfortable. “I don’t regret it,” she said.

There’s no hard and fast rule to determine whether you’ve found the right therapist. As a client, do you feel like you can communicate with your therapist? Do you feel validated and heard? Do you trust them with your genuine thoughts and feelings?

Psychedelic experiences are all about allowing yourself to be vulnerable. If you feel like you can’t open up with your therapist, you might not be able to fully let go during your session, which may impact the course of your journey and the insights you have.

Am I bringing an intention into the treatment?

An intention is like a goal. It answers what you want to accomplish with your experience, such as wanting to let go of past trauma or searching for healing. There’s no right or wrong intention to bring to a session, and you can keep it private or share it with your therapist.

Keep in mind that your intention is just a grounding framework. If your psychedelic journey takes you somewhere else and doesn’t address a specific problem, remain open to the experience and try to unpack the insights from the session.

What will my environment be like after the session?

Said another way, are you setting yourself up for success after the session?

Let’s say that you glean all of these transformative insights from your psychedelic journey. But then, you return to a space that stresses you out, doesn’t support the development of new habits, or makes you regress into old behaviors. Yikes. It might be worth revisiting how you can make small changes to keep your personal growth.

According to Elio Guesa, founder and lead facilitator of Aya Healing Retreats, part of the retreat’s screening process seeks to understand if participants have the right environment to support integration when they head home. “For a person that comes to us, it is also important to give them the right knowledge and plan to continue the work afterward,” he said.

As Guesa said, the hard work begins after the session. If a person is struggling with burnout from work, then returns to the same job and same stressors without making any other changes in their lives, odds are high that they’ll fall into the same negative feedback loops that contributed to burnout in the first place.

This doesn’t mean you need to quit your job or move across the country after your psychedelic therapy session. Instead, ask yourself how you can ensure that you’re appropriately supported after your psychedelic experience.

For example, can you ask for more support from your partner? Is it possible to talk to your manager and reassess your workload? Can you maintain a daily stress management practice, like breathwork or exercise?

Am I prepared to do the work afterward?

This question goes back to the idea that psychedelics are not a panacea for all that ails you. Your therapist might give you homework after your session, such as establishing new coping strategies to manage depression and anxiety, and it’s your responsibility to do the work to help those insights stick.

For Munay, the transformative experience of psychedelics is only one part of a larger whole for wellness, and it’s vital to integrate spiritual and psychological practices into your daily routine. “It could be yoga, breathing practices, or different types of practices that can lead us to a healthy life,” she said.

Questions to Ask Your Therapist Before a Psychedelic Session

Is this safe?

Psychedelics are generally considered safe, and they’re not associated with drug-seeking behavior.1 That said, psychedelics have their own sets of side effects, contraindications, and risks that your therapist should share with you before your first therapy session.

For example, ketamine can cause changes in heart rate and blood pressure, nausea, and slow breathing, among other side effects.2 If you want to enroll in a psychedelic clinical trial, you should know certain medications should not be combined with hallucinogens, such as SSRIs and MDMA.

What is the full process?

You should have a clear idea of what to expect from your psychedelic session from beginning to end. For example, you can ask how you’ll take the psychedelic, how soon it’ll take effect, how long the experience will last, and what it’ll feel like as the drug starts to wear off.

It might also be helpful to know what to expect immediately after the session. For example, at some ketamine clinics, you can decompress until the drug has completely worn off and you feel like you’re ready to go home.

Am I eligible for this treatment?

Eligibility depends on various factors, from your medical history to the specific psychedelic you’re taking. Generally, you may not be eligible for psychedelic-assisted therapy if you have a history of mental illness, heart conditions, or other contraindications.

If you’re applying for a psychedelic clinical trial, it’s essential to know that clinical trials tend to have strict eligibility criteria. For example, if you don’t have a formal diagnosis for depression, you may not be a candidate for a clinical trial that explicitly examines psilocybin and depression.

In other cases, psychedelic-assisted therapy is only available for specific, treatment-resistant conditions, as with ketamine. You need a diagnosis from a medical professional. If you don’t qualify, you may not be eligible for treatment.

How do I prepare for my session?

This is a common question, but it’s an important one. Your therapist can give you specific, targeted tips to prepare, such as journaling about your intention or abstaining from stressful situations and activities.

When people ask Guesa how to prepare for their first ayahuasca experience, he tells people not to watch or listen to any media about other ayahuasca experiences because it may set a certain expectation in a person’s mind.

Everyone reacts differently to psychedelics. Some people may feel euphoric and relaxed on ketamine, while others may feel anxious and detached. In addition, going into the experience with certain expectations may tilt the scales negatively because you’re expecting a particular outcome, rather than remaining open to wherever the journey takes you.

Guesa also recommends that people begin a spiritual practice before their session. That might look like journaling, mindfulness meditation, breathwork, yoga, or anything else that helps you feel more grounded.

What is your training with psychedelic therapy?

There isn’t a single formal certification or training process for psychedelic practice (although Oregon will have training programs for psilocybin service center facilitators in 2023). Instead, this question can help you understand your therapist’s experience with psychedelic-assisted therapy and whether or not they’ve worked with this drug.

Experience matters because working with a person who has taken psychedelics is pretty unique. These substances can open up a person’s mind to reveal deep-seated traumas and painful memories in a short amount of time. Psychedelics may also support neuroplasticity, or the brain’s ability to learn and form new connections, which is helpful in a therapeutic context.3 However, a therapist needs to have the training and experience to help constructively guide a person’s experience.

Ask if your therapist has worked with this drug before, what kind of outcomes they’ve seen with other patients, and why they want to work with this drug in particular.

How many times will we need to meet?

It’s tough to give an exact number of therapy sessions, but your therapist should be able to provide you with a ballpark estimate of how many sessions to expect and how many work with your budget.

For example, some ketamine clinics offer single-session therapy options, while other providers may suggest as many as six treatments a few weeks apart. It depends on your needs and what the provider recommends.

What methods will you use in addition to psychedelics?

There are many different approaches to therapy, and it’s not uncommon for therapists to combine other methods, such as art therapy, music therapy, or EMDR therapy. Psychedelic-assisted treatment may be paired with talk therapy (aka psychotherapy), but it can also be combined with other strategies based on your needs.

After your assessment, your therapist should be able to explain what methods they think might be helpful (and why).

What should I expect from this treatment?

Your therapist should explain how the treatment will make you feel and why it might be helpful for your condition. For example, some people feel better after just one ketamine infusion, but others may require more sessions before they feel any improvements in their mental state.

How much will this treatment cost?

Unfortunately, psychedelic-assisted therapy isn’t usually covered by health insurance. This question is important to ask before your first therapy session so you and your therapist can plan accordingly.

You might not have to pay for treatment if you’re receiving psychedelic therapy as part of a clinical trial. However, you may have to pay for expenses associated with receiving therapy, such as transportation and childcare costs. Before your first treatment, ask the therapist or research team if you will be paid for your participation or if your expenses will be reimbursed.

How will we assess my progress?

This question hits on the idea that you won’t suddenly be 100 percent better after your first session. Therapy is hard work, and part of that work involves measuring any changes in your mental state over time.

Your therapist may use reporting measures like questionnaires to measure your progress, or they might use external measures like whether you’re maintaining healthy habits like sleeping well, exercising regularly, and managing your stress levels.

Final Thoughts

Psychedelic-assisted therapy is a promising treatment option for people with treatment-resistant conditions. However, it’s not a cure-all. Like any other form of mental health treatment, psychedelic-assisted therapy involves work before, during, and after the session. Therefore, it’s essential to ask your therapist (and yourself) questions about the treatment to make sure you’re set up for success.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056407/
  2. https://www.ncbi.nlm.nih.gov/books/NBK470357/
  3. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.724606/full