Context: Set and Setting

Long before Western-scientific research models, the use of sacred plant medicines in healing ceremonies and cultural practices among Indigenous Peoples since Time Immemorial, places great emphasis on environmental context and psychological factors brought to the experience, such as having a clear intention and an open, enquiring attitude (Labate, 2014; Loizaga-Velder and Verres, 2014; Nettl, 1956; Tupper and Labate, 2014, as cited in Carhart-Harris et al., 2018).

With the development of psychedelic treatment models within a scientific research setting in the 1950s and 1960s, the importance of psychological and environmental factors was quickly appreciated, known as set and setting (Leary, 1961).

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Set

Set refers to the mindset of the client leading into the psychedelic medicine session. The mindset is comprised of aspects of character and personality traits, expectations, and intentions (Leary, 1961).

Setting

Setting refers to elements of the environment, including physical décor and furniture, the therapist(s) or guides accompanying the client, and music (Leary, 1961).

Video: Set and Setting

10:23

In this video, Dr. Stephen Thayer talks more about the crucial aspects to set and setting.

Context

In recent publications, set and setting have been subsumed under the umbrella term context and have also been referred to as extra-pharmacological factors. There has been sufficient empirical analysis to suggest that context indeed influences clinical outcomes in psychedelic-assisted therapy (Carhart-Harris et al 2018).

In particular, a mindset of enhanced readiness and openness, with clear intention and a positive therapeutic setting predict peak mystical type experiences which subsequently predict enhanced wellbeing.

By contrast, decreased readiness, less intentionality, and lower trust in the people supporting one’s experience predict more challenging experiences which are then negatively correlated with an increase in wellbeing (Carhart-Harris et al 2018).

Video: Numinus Health: The Drive

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Watch this brief video to get a sense of the setting used by Numinus at one of the psychedelic-assisted therapy locations.

Justice, Equity, Dignity, and Inclusion

It is important to recognize that psychedelics can greatly enhance suggestibility and promote powerful shifts in attitudes, beliefs, and worldviews. Because of this fact and in combination with the powerful influence of mindset upon outcomes, therapists must realize the great responsibility they carry not to unduly influence a client with the insertion of particular biases, belief systems, ideologies, or personal agendas during Preparation Sessions, Medicine Sessions, or Integration Sessions.

Reflection

What are some ways that you can help to establish a good set and setting with your clients during Medicine Sessions?

References

Carhart-Harris, R. L., Roseman, L., Haijen, E. C., Erritzoe, D., Watts, R., Branchi, I., Kaelen, M. (2018). Psychedelics and the essential importance of context. Journal of Psychopharmacology, 32(7), http://dx.doi.org/10.1177/0269881118754710

Leary, T. (1961, September 6). Drugs, Set, and Suggestibility [Paper presentation]. 1961 American Psychological Association annual meeting.