Q&A: Setting Up and Managing Expectations

BCSP

“There are so many extravagant claims about the benefits of psychedelics. Will taking these substances make a user happier? Or more creative and productive?”

Rajan Grewal

“There’s evidence that psychedelics can help with some psychiatric conditions, like depression and PTSD. Those are things that we have some evidence for, in carefully designed contexts. Psychedelics are different from a lot of substances—the context is hugely important in determining the outcome, so we can’t really talk about what the psychedelics do without talking about for whom, in what context, in what situation and what the person is already dealing with at baseline. It’s very case-by-case, and each person needs to have an individual analysis comparing potential benefits and risks, when taking a psychedelic in a specific time and place and social context.”

BCSP

“How can someone manage their expectations about a psychedelic experience?”

Rajan Grewal

“It generally helps to go in without very specific expectations about what’s going to happen. That’s how we approach it even in research settings. People come in with a hope that this will be helpful, but ultimately we don’t know the outcome, and that’s what we’re studying. Part of the expectation for each session is to come in with openness to having a new experience that unfolds in a way that may not be predictable or expected. There’s a really wide range of different experiences that people can have, even in research settings. We control for a lot of variables, but we can’t control for them all.”

BCSP

“How can someone determine which drug will deliver the outcome they want?”

Rajan Grewal

“I don’t think it works quite that way. If it does, we don’t have the sophistication to know that yet. There’s a lot of variability in terms of how people respond, even dose-to-dose with the same exact substance. Maybe someday, with more data and knowledge, we’ll be able to predict that better. But with different doses and different contexts, we can’t guarantee an exact outcome to a specific drug.”

BCSP

“How can a user find the right therapist and avoid the wrong one?”

Rajan Grewal

“There’s currently no legal way in the U.S. to practice as a psychedelic therapist or guide outside of legal research settings, so we don’t have an infrastructure established to support people who want to have psychedelic experiences with a guide or therapist. (Ketamine is the exception.) But I can say that it would be necessary to be with someone who was trustworthy, reliable, emotionally supportive, and able to look out for the person’s safety.

All of the criteria that would apply in finding a therapist generally would also apply in finding a psychedelic therapist. I think you would also want someone who has particular knowledge about the substances themselves.

There’s also the issue of vulnerability in that context. People are in a lot of vulnerable situations in healthcare, like getting surgery or a physical exam. This is different, because it’s physical but also deeply psychological. Feeling trust and sense of safety with the person becomes much more important.”

BCSP

“What questions should a user ask a potential therapist or guide about touch?”

Rajan Grewal

“When someone comes to me in a research setting in preparation for having a potential psychedelic experience, we talk about touch before any drug is taken. That conversation is in the broader context of getting to know the person and what their past experiences have been. It means asking what comfort looks like to them and explicitly saying, “Is touch OK with you? If so, what kind of touch? Can you demonstrate what that would be?” It could be something like a hand on a hand or on their forearm or holding hands. It needs to be explicitly talked about and demonstrated and agreed upon: This is what comfort looks like to me, and this is a way that I feel comforted.”

BCSP

“How should a user ensure they get what they want out of the experience?”

Rajan Grewal

“The word ‘ensure’ is what makes this really hard to answer. There’s a lot that people can do to set themselves up for the best possible experience or the most comfortable experience for them, but I don’t think it’s really possible to ensure it. 

I think it’s probably more helpful to come to it with thoughtfulness, a spirit of openness and curiosity, and a desire to learn about themselves, rather than an expectation of having a mystical or transformative experience that’s going to cure them. In that case, preparation should include tempering expectations and having a support system, so that whatever happens during the experience can be processed afterwards.”

This interview was edited for length and clarity.