As a therapist, I have one job, and that is to create the causes and conditions under which my clients are able to sufficiently access safety in their nervous systems so they are able to emotionally regulate. In the safety of regulation and the bounds of the therapeutic alliance, they are then able to encounter the parts of themselves that are over- or under-functioning neurobiologically in service to their safety, and try and restore homeostasis or an equilibrium in the mind/body complex.
There are many factors that play into the conditions for safety to occur, and the greater the trauma is, the longer this can take.
This is why a therapeutic process is a true one-to-one collaboration between therapist and client, blending our shared experiences and neuroceptive capacity to co-regulate with each other. In the psychedelic therapeutic research community, there is a great emphasis placed on what is known as set and setting. This basically refers to how to prepare a client for taking a psychedelic such as LSD or psilocybin, so that their session is optimised for their therapeutic experience.
Many of us in the therapeutic sector are watching the global and Australian research and application of psychadelics with interest as there appears to be significant outcomes with treatment resistant conditions such as C-PTSD, PTSD, OCD, eating disorders and depression. While Australia is potentially some years from passing legislation to legalise therapeutic prescription of what are currently classified as Class A illegal drugs, the US, UK and Europe have progressed from trials to active legal treatments with promising results.
I trained in breathwork because of my interest in working with treatment-resistant trauma, as it is one of the somatic therapy modalities that mimics some of the outcomes of psychedelic therapy, and I wanted to be able to assist people who were suffering now, not when our legislators were ready to navigate the political minefield of legalising Class A drugs.
Which brings me back to set and setting. As a therapist in all the ways I practice, set and setting is critical. I also include another two S word into the mix – scope and service.
Set and setting speak firstly to the client’s mindset – are they prepared and in the right frame of mind to encounter the magnitude of a breathwork journey where they may encounter the wild and wonderful things which happen when we get out of our own way and allow the nervous system to unwind trauma? They need to be guided to begin their preparations well before the session, which may include intake sessions, and things like pre-session physical preparation, increasing meditation and mindfulness leading up to the session, as well as what the integration work will look like directly after and following on from the breathwork experience.
The setting is critical in ensuring an optimal experience. Is the space safe, is it clean, is it comfortable, is it warm/cool, have all the client’s needs been anticipated and are they able to be met, is everything electronic and server-based working, has a playlist been curated that is appropriate to the arc of their journey?
The setting, like the set, actually also begins before the session, as it extends to all parts of the interaction I have with clients, from how I respond to emails, to how accurately my website represents me and the experience they will have, to the location I selected for my premises. I am paving the way for a cohesive and consistent experience in these actions and building the therapeutic alliance here as much as when we are in session.
I add to set and setting the additional elements of scope and service. Scope is my awareness of my own capability to work with the client safely and competently. If I have any indication that for whatever reason I am not the person to be guiding the journey or the therapy session, I need to honour that for the client. Sometimes this is the case, and it is always the right thing to set a clear boundary for what is ok and what is not ok.
Scope considers my skills and experience, but also more immediate conditions like physical and mental health. It takes full focus (in my opinion and practice) to hold space for clients, and if I’m caught up in my own emotional drama, or simply tired or unwell, I need to consider whether I am able to deliver on my promise and commitment to my clients to offer unconditional positive regard.
Like my clients, I need my own mindset to be right, so I too have to begin the work of meeting them where they are and aligning prior to the session so I can be in sympatico for their whole experience. Service is my final S, and this is a micro as well as a macro element of the delivery of therapy. I am here in service to my client and the transformation of their suffering. That is my single focus and the motivation for the doing of the being that is in some ways completely removed from any transactional, logistical or practical elements, but inherently connected. In service, I give myself wholly to the client’s needs.
This is not without boundaries, but it is as selfless as I can muster. I see this as a spiritual experience as well as a terrestrial one, where for a moment in time, I surrender myself to the perfection of the human in front of me, and their wholeness.
From that intention of service, the session can only be held in a way which is celebratory, empathetic, reverential and boundaried. It also allows me to be the fullest expression of myself as a therapist, agile and tuned to the nuances of the session, and energised to the outcomes. Using ‘the four Ss’, the preparation and delivery is mutually committed between client and therapist, which is of course where the most transformation can occur.