Preparation therapy is psychological work undertaken before a psychedelic experience. In clinical care, it may include understanding a person’s mental health symptoms and concerns, explaining what treatment involves, discussing possible difficulties, and establishing a plan for support around the active experience. Its purpose is to support informed decisions and address concerns before proceeding.
Preparation gives you time to understand the proposed care and gives your treating team time to understand you. Your current symptoms, treatment history, and circumstances all need consideration before a decision to proceed.
Why is preparation important before a psychedelic experience?
Psychedelic experiences can involve unfamiliar and strong changes in perception, strong emotions, and psychological distress. How someone experiences those changes may be influenced by their mental state, surroundings, and the support available to them.
Preparation provides an opportunity to discuss those possibilities before someone is in an altered state. It also gives people time to get to know the clinicians involved, build rapport, explain concerns, and understand how support during and immediately after will be provided.
For someone with a trauma history, or who may have had extensive mental health treatment, being with unfamiliar people or feeling a loss of control is important to address during preparation. These concerns need individual attention rather than reassurance that the experience will take care of them.
What does preparation for psychedelics include?
Psychological preparation is tailored to the person and the clinical context. It may include:
- Reviewing current mental health, previous treatment, and any experiences that could affect the proposed treatment protocol.
- Explaining the treatment process, its uncertainties, associated risks, and the range of experiences that may occur.
- Exploring concerns and questions about the experience.
- Exploring and planning how distress would be recognised and managed.
- Developing a working relationship with the treating clinicians, consent and professional boundaries.
- Coordinating care and clarifying the support available afterwards.
These discussions may identify issues that need further assessment or treatment first. Preparation can therefore lead to a decision to postpone, reconsider, or pursue another form of treatment.
Psychological preparation is the second phase after suitability screening and assessment. Medical suitability, physical health risks, and medication interactions require assessment and overview by the Authorised Prescriber psychiatrist. Screening and assessment phase must occur before moving to preparation with a psychologist.
What can happen without adequate preparation?
When preparation is limited, important concerns may remain unrecognised or unresolved. A person may enter an experience without understanding what could happen, how to communicate distress, or what support will be available afterwards.
Inadequate preparation has been linked to difficulty integrating these experiences. Possible gaps that can exist with limited or no preparation include unrealistic expectations of the journey and outcomes, new or re-emerging psychological distress, difficulty surrendering or letting go to the medicine, unfamiliarity with the treating team which can lead to nervous system overwhelm, and no clear follow-up support. These gaps can leave someone facing an already difficult situation with little information or support.
For example, someone expecting an experience to feel consistently reassuring may be caught off guard by fear or confusion. If they have not discussed how to ask for assistance or how the treating team might respond, it can exacerbate these difficulties.
Research has documented difficulties that persist after psychedelic experiences, including anxiety, feeling disconnected from oneself or one’s surroundings, and disruption to everyday life. A study of 608 people reporting extended difficulties illustrates the range of problems people can encounter. While this research did not examine the involvement of adequate preparation or frequency difficult experiences occurred, they are being reported more often. PLOS One
Adverse reactions can occur despite careful preparation. A difficult experience is not proof that someone failed to prepare properly, and persistent distress deserves assessment rather than being dismissed as part of the healing process. Early intervention is best in these cases.
Why do preparation with a psychologist?
A psychologist with relevant training and experience in psychedelic-assisted therapy and altered-states can consider preparation within a broader understanding of your mental health.
A psychologist looks at how current symptoms relate to your history, how you respond when distressed, and whether other care is needed. For someone living with trauma, panic or dissociation, that assessment may be particularly relevant to deciding how to proceed.
A psychologist can also contribute to an individual treatment plan, communicate with other treating practitioners where appropriate and provide or arrange follow-up psychological care. As part of the treating team, the psychologist can escalate concerns to the prescribing psychiatrist as needed.
The professional relationship matters too. Preparation should allow enough time for you to ask questions, raise concerns, and understand the clinician’s approach. You should receive a clear explanation of confidentiality, understand the process to provide informed consent, and the limits of the treatment.
The benefits of working with a psychologist trained in psychedelic-assisted therapies means they have a deeper understanding of ongoing distress post experience and can assist you to integrate that distress properly. Connecting to the right professional is a combination of appropriate training, and relevant experience.
How many preparation sessions are needed?
There is no single number of preparation sessions established as suitable for everyone.
Many clinical rials use 3 preparation sessions, and across current treatment programs in Australia it varies from 2 to 3 sessions across a range of 45-mintues to 75-minutes each session. This is not established as a universal minimum or guarantee an individual’s readiness for this treatment. Some people will require a prolonged preparation phase (Nature Medicine).
The number of appointments should reflect the person’s clinical needs, the proposed treatment and the requirements of the treating team. Relevant considerations include current symptoms, previous adverse experiences, familiarity with the clinicians and whether significant concerns remain unresolved.
Some people may need further psychological treatment or specialist assessment before a decision about proceeding can be made. Additional appointments should have a clear clinical purpose, explained costs, and opportunities to review the plan.
Psychological preparation support in Coomera
Conscious Mind Centre provides psychological care for adults in Coomera on the Gold Coast, including support around altered-state experiences. We can discuss your concerns and whether our psychological services are appropriate for your needs.
References
- Evans, J., Robinson, O. C., Argyri, E. K., Suseelan, S., Murphy-Beiner, A., McAlpine, R., … & Prideaux, E. (2023). Extended difficulties following the use of psychedelic drugs: A mixed methods study. Plos one, 18(10), e0293349.
- Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 27, 1025–1033 (2021). https://doi.org/10.1038/s41591-021-01336-3
Shai Hipperson
Shai Hipperson is a Clinical Psychologist based on the Gold Coast with a focus on PTSD, Trauma, Adverse Childhood Experiences, Complex PTSD, integration of altered states, and legal psychedelic-assisted therapy facilitator.
