On this episode of the Psychedelic Medicine Podcast, Dr. Rick Barnett joins to discuss when to not proceed with a planned psychedelic journey. Rick is a licensed clinical psychologist and licensed alcohol and drug counselor, trained in psychedelic therapies and research by the California Institute for Integral Studies. He is the cofounder of the psychedelic society of Vermont while also consulting with patients curious about psychedelic research and therapies, including helping people understand the processes of preparing for, experiencing, and integrating the intentional use of psychedelics for personal growth and healing. Dr. Barnett also works with patients in a traditional psychotherapeutic group practice and has also recently begun offering low-dose ketamine therapy.

In this conversation, Rick expounds on his recent LinkedIn article of the same title, exploring the various biological, psychological, and social experiences which provide legitimate reasons for postponing a planned psychedelic experience. On the biological side, Rick explains that sudden illness or injury could absolutely constitute sufficient reason to reschedule a therapy session, and that consulting closely with your therapist or guide is essential if the decision isn’t clear cut, as in the case of something which could be a stomach bug or just nervousness manifesting as digestive discomfort.

When it comes to the psychological side of things, Rick mentions that it is often a difficult circumstance to navigate, as mental distress is often the reason a patient is pursuing psychedelic therapy in the first place. However, Rick makes a distinction between the typical levels of depression and/or anxiety a patient is accustomed to experiencing, and a much more intense fear which is also qualitatively different that can arise before a session. Again, this is a situation where open communication between patient and therapist or guide is essential in order to help the patient make the best decision, but Rick also stresses that because this is a wholly internal experience, that prudent introspection is ultimately what will guide the decision making.In terms of the social reasons for not proceeding, Rick cites turmoil in personal relationships, traumatic contemporary events, and also recent experiences of death. These can all lead to an individual having a particularly heavy emotional burden going into a session, causing potentially difficult experiences during the psychedelic journey. While sometimes difficult experiences can be very healing in the long term, especially following effective integration, these external stressors have the potential to take people’s focus away from the intended inner work, so postponing until the person is confident they aren’t bogged down by these social factors could be prudent.

With all these factors, Rick stresses that a patient can always return to a psychedelic journey at a later time if they decide not to proceed. A good guide or therapist will accommodate and even proactively support a patient in ensuring they are coming to the experience at the right time.

In this episode:

The importance of examining refund policies of psychedelic retreats or therapy practices
Rick’s bio-, psycho-, and social considerations for not proceeding with a psychedelic journey
Why these considerations are often molecule-specific
What kinds of interpersonal conflicts may warrant postponing a psychedelic journey
Distinguishing between overwhelming fear and typical anxiety prior to a psychedelic experience
The impacts of traumatic political or social events on mental health and postponing a journey

Quotes:

“When you speak to a guide, when you speak to a coach, when you speak to a researcher, my hope is and my experience has been that it is always an option on the table at the last minute if you don’t feel quite right that you have permission to opt out.” [5:24]

“Ketamine, when it comes to physical illnesses might be a different judgment call because ketamine—dissociative anesthetic, you kind of lose sense of your body—if there’s something going on physically, that might be okay to go ahead with… because you’re not with your body as much, but psilocybin, other high dose classic psychedelics and physical illness or physical pain, that could be different.” [17:59]

“People need permission to say ‘you know what, it’s gonna happen’—you’ve done all the preparation, you’ve done all the work. If it’s not going to happen right now, it’s still going to happen.” [32:57]

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