Excerpt from The Tripsitters.org Psychedelic Guide Manual PDF:
The practice of working with psychedelics for healing or spiritual purposes is not new. Many indigenous traditions have used “sacred medicines” in ceremonial healing and spiritual contexts for centuries and underground therapists have been working with psychedelics in healing practices for decades. There are many different approaches and medicines (and combinations of medicines) used in individual, group, couple and family contexts. This manual is intended to by used by individuals who are assisting others to experience substances such as LSD, Psilocybin, MDMA, 3-MMC, DMT, 5-MeO-DMT, Ayahuasca and other psychedelics. It is intended to be a guide for therapists using moderate to higher dosages of a psychedelic. It is not intended to offer guidance for those who are involved in psycholytic therapy which is psychotherapy enhanced with a low dose of a psychedelic. This document has been developed over many years with a wide variety of individuals who have contributed to its development, making this a community effort. This manual is not intended to offer training in a specific model of therapy (e.g. cognitive behavioural or Imago Relationship therapy) and it is assumed that many individuals who use this will be skilled practitioners in a wide variety of different therapeutic approaches, all of which could be enhanced by the information in this manual. Having skills in the art of therapy can be helpful in navigating the complex terrain of transference and countertransference which are generally amplified by psychedelics. In the development of the future profession of the “psychedelic psychotherapist/supervisor/guide”, a manual of best practice needs to evolve. This document is offered as a beginning to this process.
Psychedelic guiding has three stages; preparation, experience and integration. Thoughtful attention to all three stages is needed to maximize the opportunity for a positive outcome.
Set and Setting
The scientific, clinical, and anthropological/spiritual literature on the use of psychedelics emphasizes the importance of “set” and “setting”, which, when thoughtfully incorporated, are integral to gaining the greatest therapeutic benefit, maintaining ethical boundaries, and avoiding untoward effects.
“Set” refers to the mindset of the participant: the person’s beliefs, hopes, fears, personality, and expectations. Commonly associated with the advanced psychological preparation of the participant, set is also considered to be the state of mind the participant is in on the day of psychedelic ingestion.
The “setting” of the experience is also important. The space should be professional, private, safe, attractively decorated, relaxing and comfortable. Sound transmission to others who are not involved should be limited (or preferably non-existent). Plants, specifically flowers (a rose is traditional), offer beauty and nature. Being inside a warm, secure, safe and private environment allows the participant (and the guides) to be free of worries about interruption, and facilitates the desired inward experience for the participant. All equipment and personnel for the safety and implementation of the process should be easily accessible.
The space needs to be outfitted with a music system and headphones to play a music playlist, and participants will be encouraged to recline, with their eyes covered, on a comfortable sofa or bed for the majority of the session. Using appropriate music, and limiting external visual distraction with the use of eyeshades, facilitates an inward, deeply personal experience.
Creating a supportive set and setting includes:
- Building a relationship between the participant, and the guiding team, in order to develop rapport, safety and trust.
- Ensuring a familiar, secure, comfortable, and safe physical, psychological, and social environment.
Ritualizing the Process
Metzner (2015) has explored different elements of psychedelic rituals (e.g. singing, chanting, drumming, working with “sacred” objects) which are often used in a wide variety of indigenous traditions. A ritualistic approach to a psychedelic session has a number of advantages. Rituals can be imbued with a wide variety of meaning and therefore make the experience more personally meaningful for the participant. Healing and spiritual rituals can be “generic” and therefore be appropriate for individuals with a wide variety of healing or spiritual needs.
Rituals can be powerful in the creation of a container of safety. They can be “used as appropriate” in response to distress or challenging behaviour. A singing bowl or gong, for example, can be used to signify change. Here is where music can be particularly important. Communicating with music is cross-cultural and not prone to the complexity of possible misinterpretations and disagreements which can occur when communicating with words. The possibility of misunderstanding words is amplified when altered states of consciousness are involved. Music can be more appropriate than words when communicating with someone in a psychedelic state of consciousness, as the meaning of words is often state-specific and the interpretation of music is more universal. An example of appropriate communication with music occurs in Ayahuasca ceremonies where traditional Amazonian shamans interact with westerners seeking healing. If words were shared, the different world views would probably conflict, as shamans often believe that psychological problems are the result of “bad spirits” and the western belief system focuses more on issues like past trauma. When music is the medium of communication, the disagreements are minimal and healing is promoted.
While rituals can be powerful in bringing safety and meaning to the experience, they can also be problematic. If the rituals are not “in sync” with the participant, or if the guide believes that their particular brand of ritual is special, and the healing is then attributed to the healer and not the participant, this can be a disempowering experience for the participant. Rituals can also be inflexible and not adapt to changing circumstances. An Ayahuascaro who refuses to use disposable cups when running a group of individuals with addiction concerns who have high rates of Hep C and HIV can increase disease transmission. The explanation that “this is our tradition” is poor consolation to anyone newly infected. Skillful use of rituals requires the guides to be flexible and also remind themselves of the importance of humility and that the healing comes from the participant not the guide.
Guides’ presence, intentions, assumptions, actions, theoretical knowledge, skill sets, personalities, and intuitions (essentially the entirety of their body, mind, and spirit) influence set and setting. The individuals come to this work from a variety of professional disciplines, training backgrounds, and philosophies. Divergent interests, skills, and experiences are beneficial to the development of best practices, as many perspectives are needed to ensure the highest quality process.
Effective psychedelic treatment session guides act to facilitate the journey into conscious awareness, with full presence and integrity toward the individual, informed by science and medicine. Instead of acting as interventionists, guides serve to provide security and comfort without intrusion, by establishing rapport and trust with the participant, and by maintaining an aesthetic, comfortable setting in which the participant feels safe.
When non-ordinary states of consciousness are occurring, guides remain steady and centered. It is essential that the guides engender human warmth and infuse the setting with a sense of groundedness. They must also adhere to rigorous guidelines, and be knowledgeable about the specific medicine they are using.
The guides appreciate that the participant is a collaborator and co-investigator – a brave individual who journeys into unknown terrain, and returns to assist us all by sharing aspects of their journey that may be useful for their growth and awareness, as well as for the growth and evolving skill of the guide.
It is essential for the guides to have the utmost of trust in the entire process – in their skills, their team, and the participants. Equally important is the cohesiveness of the team as a whole, with every guide resonant with whomever they are paired with, as well as being mindfully aware, supportive, and communicating openly with other members of the team. Members of the therapy team who are paired together to co- facilitate a psychedelic treatment session should spend time together with the focus of developing a trusting interpersonal relationship where open communication is possible. This relationship fosters learning for both guides, and allows for a constructive, healthy debrief at the end of the session.
Inner Healing Intelligence
Inner healing intelligence is a concept used throughout this manual. This concept was originally developed by Stanislof Groff and refined by Michael Mithoefer, who has made this central to the MAPS MDMA-assisted treatment process. This concept is used to help put the participant in touch with their innate ability to heal and grow, and to empower the participant to be responsible for their own healing. Turbulent and often difficult emotional processes may be easier to work with and resolve when understood to be part of the Inner Healing Intelligence. The following explanation may be helpful in discussing the concept with participants: The body initiates a remarkably complex and sophisticated healing process and always spontaneously attempts to move toward healing, as evidenced by the inevitable healing of a cut or a bruise, for example. The psyche too exhibits an innate healing intelligence and capacity, which is revealed by psychedelic medicine. Guides who understand the concept of the Inner Healing Intelligence are less active (and more empowering) than therapists who believe that their interactions with the participant will result in the healing process.
The Role of the Guide
The role of the guide is to attend to the physical, personal, safety, and other interpersonal needs of participants, with full attention and open acceptance, while avoiding “care-taking”, psychoanalysis, fixing, labeling, diagnosing, or being distracted.
Qualities of Guides
The following qualities and skills sections was adapted from Karen Coopers Guide Manual (2014):
A Knowledgeable, Skilled and Wise Guide:
- Has the experience and wisdom to understand the degree of activity of the role and generally not act as an “inactive sitter” or “overactive guide”, but can act in either of these roles as required.
- Prepares for everything, and assumes nothing.
- Has the skills to cope constructively with hazards and obstacles of the psyche.
- Knows when not to intervene, and knows when and how to assist the process.
- Has a full appreciation for being alive, lives a meaningful life, understands that we are all “wounded healers”, knows some of the agonies and ecstasies of human existence.
- Has an understanding of the pharmacology (e.g., mechanism of action, typical timing of onset, duration), and expected or possible effects of the medicine.
- Trusts both the psychedelic medicine and the participant’s internal healer to find the process of healing for the participant.
- Has the ability to stay relaxed and grounded in the presence of intense anxiety and other emotions that may be expressed emotionally or physically.
- Has appreciation for the mystery of their own being.
- Has awareness of content beyond the ego.
- Understands awe/respect toward transcendence.
- Understands that encounters with transcendence can be meaningful, significant and life-transforming.
- Maintains the ability to remain objective; uses discernment rather than judgment.
- Is able to avoid using or relying on labels such as “psychosis”, “freaking out”, or “bad trip”, and is able to respond mindfully to observed behaviours and perceptions.
- Personally understands the benefits that can be obtained from altered states of consciousness.
- Has an ability to shift between mode of scientist and mode of poet and compassionate presence, drawing on each as appropriate.
- Appreciates that sessions are like a piece of art created in collaboration with the participant. Each experience is unique and involves accessing intuition, expression of feeling, being vulnerable, and waiting to see what unfolds.
Knowledge of the Human Mind When Seen Through the Lens of Psychedelics
Guides should be aware of the range of different theories that have been developed to understand the nature of the conscious and unconscious mind as it manifests under the illumination of psychedelics. Currently these models are still under development and wide-ranging, as followers of Grof observe the Birth Primal Matrix, Freudians observe Oedipus, Jungians see archetypes, and neuroscientists see the suppression of the default mode network. An understanding of these different theories is required for any guide who supervises the psychedelic experience.
Knowledge of the Power and Importance of Human Relationships
- Follows all relevant professional codes of ethics, in addition to the ethics outlined below.
- Maintains non-manipulative, non-exploitative relationships; has clear and appropriate structure, and personal and professional boundaries.
- Understands transference and countertransference and is able to demonstrate the ability to self-reflect on, and discuss these issues, as appropriate.
- Understands the power imbalance that occurs in the relationship between the participant (who is extremely disclosing and vulnerable), and the guide (who is seen as being the “wise one”). There are a number of possible concerns here, as it is easy for an immature guide to start to believe that they really do have the answers, and start to believe that they are “the great therapist”. The appropriate response is humility (not ego inflation), and the ability to see the participant’s issues as being a normal part of humanity that we all share and holding an openness to learning from the participant. Metzner (2015) cautions guides to be ever aware of the potential for their own grandiosity and the over-idealizing of their perceptions of what is meaningful in states of consciousness associated with psychedelic-assisted therapy. As prevention is better than damage control, an open, ongoing discussion among guides on this issue during staff meetings is advisable to build and maintain healthy team functioning.
Appreciation for Human Suffering
- Has an appreciation for “Purgation” and “Dark Night of the Soul” as part of the spiritual journey.
- Provides steady compassion during pain (physical and psychological).
- Appreciation for the limitations of language, and ability to withhold questioning.
- A participant who has a psychedelic experience often describes the experience as having a quality of ineffability and paradox: beyond words and encompassing truths that otherwise might seem incompatible or opposite. For example, one may have altered perception of time, prefer to not talk about, or be unable to describe their experience.
- Likewise, a participant may have difficulty activating their voice to make their speech coherent and intelligible while the psychedelic medicine is in effect.