Ever since psychedelics started to be used widely again in the 1960s, the importance of set and setting has been emphasised.

Set is the person’s internal state, the beliefs, expectations and current mindset of the patient. This includes their reason for taking the psychedelic, their intention for the trip. Is it for ‘therapy’ because they have a problem/diagnosis that is troubling them. Or is the intention personal growth and transformation, perhaps a mystical experience or meeting with a wider Consciousness. Of course in practice the two often overlap, but the former fits within a medical model, whereas the second does not.

As Michael Pollan writes, beginning in the early fifties, psychedelics had been used to treat a whole host of conditions, including addiction, depression, obsessive-compulsive disorder, schizophrenia, autism, and end-of-life anxiety. There had been forty thousand research participants and more than a thousand clinical papers! He continues, It was one thing to use these drugs to treat the ill and maladjusted – society will indulge any effort to help the wayward individual conform to its norms – but it is quite another to use them to treat society itself as if it were sick and to turn the ostensibly healthy into wayward individuals.

Setting is the surroundings where we ingest the compound, the current environment and the broader socio-historical context. This includes the presence of the therapist or sitter if you have one as well as the environment you are in at the time and returning to immediately after the trip.

An excellent paper titled Predictors of psychedelic experience: A thematic Analysis lists three positive internal predictors for a trip.

• Understanding: informed participants have much better experiences
• Mindset: surrendered mind set leads to much better experiences than resistant mind sets.
• Motivation: some people take the substance to avoid their reality – escapism. Others are motivated by self-exploration and curiosity, deeper self-understanding.

And three positive external predictors

• Nature: It has the capacity to amplify and shift the experience. Also helps ground you and bring you back to the body.
• Music: It has the capacity to amplify and shift the experience.
• Preparation: Creating an atmosphere of trust and safety before you start.

Within all psychedelic assisted therapy, there is at least one sitter with the patient at all times. The sitter must be a person that the patient trusts, and many argue (I totally agree) that the sitter must be familiar with the psychedelic landscape that the patient is entering. An analogy often used, is would you choose a swimming teacher that had never been in the water?

Sitters can help guide and give confidence. Their job is just to make the space safe and comfortable. I am with you, you are not alone, you will come through this. Annie and Michael Mithoefer have led thousands of psychedelic, MDMA and Holotropic Breathwork sessions and as they put it, the most important thing for everyone in the room is to stay there fully with presence.

In sessions where the intention is personal growth/transformation/a peak or mystical experience, it is also advised to have a sitter for safety and reassuring presence. Experts like Christopher Timmerman argue (apologies, I cannot find the reference for this talk) that in such cases it is even more essential that sitters need to be as adequately prepared and experienced in psychedelic states as possible, not only to assist during the trip itself, but to help with integration afterwards.

Almost all of the clients that I see who are facing difficulties after a psychedelic experience, have not fully or correctly engaged in the preparation of set and setting, or have been without a trusted sitter (or at worst have experienced an abusive sitter). More on these two topics in my next two pieces.