This article was previously shared in the Psychedelic Alpha “Psychedelic Practitioner” newsletter.

You’ve prepared over the course of weeks or months, and your client may have been waiting for what feels like an eternity: dosing day is finally here. How is the therapist to balance the demands of keeping clients safe, managing expectations, and maintaining hope for the most positive outcome? While dosing day may be the most highly anticipated moment in the psychedelic therapy process, it can also bring a number of challenges and carry immense uncertainty. This can distract therapists with anticipatory anxiety and worry.

While there truly are many details to attend to—room preparation, supply lists, sound checks, screening questions, transportation arrangements, and more—the key principles guiding dosing day are generally very simple. Client safety should be the organizing principle behind everything. Learning how each of the details relates to safety can make them feel more logical and easier to follow. Therapists’ behavior and actions are also guided by this principle, with the understanding that a balanced, attentive, and professional demeanor is part of what supports a successful dosing day.

Another key principle of a dosing session is managing expectations, including your own. You may be hopeful for a particular client’s outcome or dread their disappointment if profound change is not immediately apparent by the end of the day. We ask clients to remain open-minded about their psychedelic experiences; it is essential that therapists cultivate and model open-mindedness as well. During dosing days and throughout the integration phases of treatment, curiosity and a willingness to explore what is actually happening serve as antidotes to premature conclusions and open the door to long-term change.

As the field evolves and more therapists have opportunities to guide clients through dosing sessions, the possibilities for learning are expanding exponentially. With client privacy and confidentiality always in mind, finding appropriate opportunities to debrief with clinical team members, colleagues, trainers, or consultants supports continued reflection on dosing sessions and the work that surrounds them. There is also a wealth of resources created by people who have undergone psychedelic therapy to enrich these conversations, often in the form of essays and books, podcasts, and recorded conference talks. At Fluence, we offer a growing number of CE courses that include video and discussion of real psychedelic therapy sessions. 

Learning should always be an ongoing endeavor that includes time for listening, reflecting, and integrating. Your experiences and insights as a therapist are a vital contribution to the growth and enrichment of the field.