Psychedelic Medicine: The Risks of Uninformed Use and EXPANDED’s Responsible Care Model
The growing use of psychedelic-assisted therapy, including ketamine-assisted therapy (KAT), has opened doors to profound healing for individuals struggling with depression, anxiety, PTSD, OCD, and existential distress. However, as these therapies become more widely available, the lack of proper training and experience among those administering these medicines has become cause for concern.
While thousands of individuals have had positive, life-changing experiences working with psychedelic medicine, they are not a panacea. And while they are typically extremely physically safe to consume, psychological harm can still occur outside of appropriate and informed use.
These substances, like psilocybin and ketamine, are considered “non-specific amplifiers”, meaning that they tend to amplify the mind’s inner workings—both its beauty and its chaos. Without the support of an extensively trained therapist, deep preparation, and an intentional structure for integration, clients can be left feeling more disoriented, vulnerable, or even psychologically at risk than when they started.
For this reason, EXPANDED is continuously iterating our Responsible Care Model to ensure that not only are clients safe, but that their experiences —positive and enjoyable or difficult and uncomfortable— translate into meaningful and lasting behavioral change.
The Risks of Uninformed Psychedelic Therapy
1) Psychological Risks: The Mind’s Door Opens Beauty and Pain
Psychedelic medicines can unearth repressed trauma, existential distress, or overwhelming emotional content. Without a skilled guide who understands how to navigate these states, a client can feel unmoored, confused, or even retraumatized. A trained therapist knows when to lean in, when to hold space, and when to intervene with grounding techniques to ensure that the experience remains productive rather than destabilizing.
Even profoundly positive experiences can feel disorienting or overwhelming! In these cases, individuals can also benefit from skilled support, guidance and connection.
2) Serotonin Toxicity: The Hidden Danger
Many clients—especially those already on SSRIs or other psychiatric medications—may be unaware of the risk of serotonin syndrome, a potentially dangerous condition caused by excessive serotonin in the brain. A knowledgeable provider will thoroughly assess each client’s medical history, coordinate care with prescribing psychiatrists, and tailor the treatment plan to prevent complications.
3) Integration: A Common Missing Piece
Ketamine therapy, or psychedelic therapy, differs from ketamine- (or psychedelic) assisted therapy. Ketamine- (or other psychedelic) assisted therapy means that you are engaging with the medicine as an ally to deeper work, with the support of a trained guide or therapist, as opposed to when patients are passive recipients of a substance.
For example, I have worked with patients who, in ketamine therapy, typically received ketamine through an IV drip while watching TV alone in a clinic room. Several patients who have started their psychedelic medicine treatment here are surprised at how different the experience is within the context of our model.
Ketamine-assisted therapy, like most things, requires financial resources, time and effort, and focusing on integration helps you get the most of out of the resources you invest into this experience. Psychedelic insights can be profound, but without proper integration, they remain just that—insights.
For this reason, EXPANDED utilizes a “12-20” model.
The “12-20” Model
The 12–20 week model is designed to provide clients with the structure and support needed to ensure that their ketamine-assisted therapy experience is not simply a fleeting trial-and-error attempt at improved wellbeing, but a catalyst for positive and sustainable change.
This timeframe allows for:
Thorough preparation— including appreciative inquiry, intention-setting, breathwork and a resource guide containing suggestions on what to do/not do leading to up dosing day— so clients feel mentally and physically safe in the days before their sessions
A series of client-specific ketamine sessions that build on one another for deeper therapeutic work and processing
Integration sessions to turn insights into real behavioral shifts
Ongoing therapeutic support to reinforce healing and growth
The Importance of Time: Holding Space for All Possibilities
Psychedelic experiences are largely unpredictable. A guide or therapist must be prepared for everything from emotional breakthroughs to moments of panic, discomfort or dissociation to nothing happening at all. This model affords time and flexibility for a range of outcomes, deeper work and supportive, in-session activities.
We do not believe it is ethical or beneficial to require that patients commit to a timeframe or to purchase sessions up front. Your time is yours, and we are heavily invested in curating a plan that best fits your needs, history, pace and personal story. While some clients’ time with us is longer or shorter, and sometimes we spend more or less time on certain areas, the typical flow for most of our patients in the 12-20 model is:
• 4-8 preparation sessions to clarify goals, set intentions, create psychological safety together, and learn basic breathwork and nervous system regulation to ensure clients have the information they need
• 4-6 dosing sessions in the “city sanctuary”, including wellness items like a heated PEMF mat and meditation sound bells, healthy beverages and snacks, comfort items and curated playlists with eye mask and high quality headphones for an optimal experience
• 4-6 post-dose integration sessions to support clients in processing their experiences and translate newfound awareness and beliefs into new behaviors
The most sustainable and healing transformation comes from translating your insights into actual behavior change, so they can work for you, every day.
The Bottom Line: Experience Matters
Psychedelic-assisted therapy holds immense potential when conducted with a trauma-informed approach and tailored methodology. With proper training, experience, and an intentional structure, these medicines can be used to facilitate deep, life-changing healing. Without it, they can lead to confusion, re-traumatization, or ineffective care.
If you’re considering ketamine-assisted therapy for yourself or a client, I invite you to explore a safe, structured, and deeply intentional approach—with science, skill, and soul.
