Many people have questions about the process of psychedelics-assisted therapy itself and how it is carried out in practice. When I was about to try the process myself to quit smoking after 18 years, there was some information I had to go through. Although there are variations between the clinical trial protocols and some changes have happened since the 60's, some elements seem to be more or less universal. I'll go through these here.
The first step is the qualification for psychedelics-assisted therapy. You often get a number of forms to fill out, focused on a history of physical or mental illnesses. Candidates who have experienced psychosis or are diagnosed with bipolar disorder, or have it in close family (parents or siblings), are disqualified. Still, many who have had psychotic experiences and bipolar disorder say that they have had good therapeutic effects from psychedelic experiences. The world's most experienced researcher in the field, Stanislav Grof, believes that this works as therapy even for that group. I think this group is disqualified for two reasons. The first is that there is a greater risk of worsening of symptoms over a period of time and that this group often requires many treatments and closer psychiatric follow-up. And since it is a risk-exposed group, there is also a greater chance that the study and research will be put at risk for negative publicity in the press.
In addition, it is common to disqualify patients with high blood pressure, cardiac arrhythmia or other cardiovascular disease. For MDMA, there is a direct pharmacological correlation as some of the side effects of MDMA are increased heart rate, blood pressure and body temperature. For psilocybin and LSD, it's more that mental stress is also physical strain. In addition, the therapist will review which medications you may be taking and ask you to stop with those who have interactions, and especially antidepressants (read more about which in this thorough review here).
After being qualified, the intentional setting begins. This is about defining the goal or intention of the psychedelic experience with a therapist. For me, the intention was something as simple as quitting smoking. Once defined, you begin to prepare. This can be done by talking about it with your therapist and others, and by acquiring new information. I talked to my partner a lot and read a new smoking cessation book, for example. Then you will work on getting your intention "top of mind" before the experience. I did this by sitting in silence and thinking about my intention for 5 minutes each morning for two weeks before the experience. In addition, I planned a little less to do the last days before the experience so I wouldn't get too distracted by other things. This is best done in collaboration with a therapist.
The experience itself
The experience itself takes place at a clinic or hospital where you meet in the morning on an empty stomach. The room would be a little homely furnished with a sofa, some pictures on the walls and chairs where the therapists sit. You will be given the medicine and will have approximately 30-60 minutes to talk and reflect on your intention (or meditate) before the medicine takes effect.
When you start to feel the effect, you will lie down and relax on the couch. As the effect increases further, you will receive help to put on your headphones with relaxing music and an eye mask. The combination of eye mask and music lets you focus on yourself and not be distracted by your surroundings. One will mostly lie on the couch with headphones and eye mask and take a break every hour or two to drink some water/tea, eat some fruit or take a bathroom break. If you want to talk to the therapist, you can remove the eye mask and headphones at any time. The therapist will always be in the room, and it is the therapist's responsibility to keep you safe and attend to all your needs during the experience. You often have a pen and paper available if you want to write or draw. After the effect diminishes, you will be able to sit and talk with the therapist or otherwise do as you wish, as long as you do not leave the room.
Most of the work starts after the psychedelic experience, and now you start working on how to integrate the experience into everyday life. Here you will have 2-3 follow-up sessions with the therapist to help with the integration and answer questions. Thereafter, the procedure may be repeated twice if the patient so desires, at 4-6 weeks intervals. This gives the patient time to let the insights from the first treatment calm down and integrate. Read more in the article What is integration of a psychedelic experience?