Prolonged Session Duration

Practitioners should be aware of the potential implications to their well-being that may occur by the unique circumstances of psychedelic-assisted therapy.

Session Duration

Psychedelic-assisted therapy sessions and the required therapeutic Integration Sessions extend outside of the regular clinical time requirements for session duration. MDMA and Psilocybin Sessions stereotypically last between six to eight hours, and Ketamine Sessions generally last between two to three hours.

The session duration is important to note as it requires a different level of focus, attention, and presence from the health professional. Preparing for six or eight sessions during the day is not the same as spending six to eight hours with one specific client and your co-facilitator because these sessions are especially depleting and unpredictable due to amplified arousal states. For this reason, we advocate that health professionals consider not only engaging in contemplative practices that require a sustained focus but also begin to implement some of the following self-care practices that we propose will best support you in sustaining your presence with a client for extended periods of time. Here are some examples:

  • Proper rest

  • Adequate nutrition and hydration (before and during)

  • Taking breaks (only if working in a co-therapy dyad)

  • Mindful of pacing (pause, relax, open)

  • Grounding and breathing exercises

  • Cultivating co-facilitation rhythm

  • Clearing your schedule so you can remain present without outside distractions

  • Previous practice with extended periods of focus

  • Silent meditation retreats or contemplative practices

Amplified Arousal States

Clients’ emotional and autonomic states during a Medicine Session differ from those of clients during a regular therapy session. Health professionals should anticipate clients will have enhanced access to deep or intense emotional and traumatic material. Therefore, health professionals are to prepare themselves for witnessing and supporting clients through high arousal states such as shaking, trembling, or screaming.

During Medicine Sessions, clients are likely to experience a broader spectrum of arousal or activation than in regular therapy and may access states of:

  • Terror

  • Fear

  • Panic

  • Peak experiences of ecstasy, pleasure, euphoria, mysticism, or bliss.

It is not only states of distress that become heightened but all states of being. Therefore, health professionals should prepare themselves to work with enhanced peak states that may include:

  • Arousal

  • Desire

  • Longing

  • Laughter or hysteria

This is important to prepare for as prolonged intense experiences may escalate client dysregulation requiring consistent, active-health professional, self-regulation efforts.

Health Professional Tip

As a health professional present to amplified states, an increased capacity to remain grounded and attuned despite the client’s high arousal and activation or emotional intensity is paramount.

Reflection

It is important a health professional ‘knows thyself’ and typical personal automatic responses under acute and extended stress. Ask yourself: When stressed, is your impulse to flight, flee, or freeze? Knowing your somatic response to stress will allow you to use your reaction to the client’s activation as a guidepost.

Self-Care Practices

Self-care practices are necessary to develop mindful, embodied presence, and, from here, self-regulation capacity to cultivate one's self-awareness. These skills are essential to self-identifying burnout, compassion fatigue, and vicarious traumatization. Mindfulness interventions show promise in addressing and alleviating burnout in healthcare provider (Santorelli, 2000).

Health Professional Tip

What are some ways that your capacity can be increased?

You can work to increase your capacity by partaking in any of the following:

  • Meditation

  • Practicing pause

  • Mindful movement

  • Expressive practices

  • Orienting to pleasure

  • Knowing and elaborating your resources to activate vitality or a comforting felt sense

  • Experiencing somatic therapy (as a participant)

Activity

What are your internal sign posts to know when you are feeling at rest, relaxed, and safe? You are invited to try using embodied inquiry with yourself to describe and/or label what, if any, sensations or other experiences you notice.

How can you reliably bring yourself to this state? Consider experimenting with different methods we've learned so far, like direct embodied resourcing (e.g. with a breathing or grounding exercise) or external resourcing (like calling to mind something you're grateful for, a place or situation where you felt most yourself, or at ease), then using embodied inquiry to bring this to present moment embodied self-awareness.

References

Santorelli, S. (2000). Heal Thy Self: Lessons on Mindfulness in Medicine. Harmony.