Set and Setting in Psychedelic-Assisted Psychotherapy

Imagine yourself in McDonald’s.

You’re hangry, and have stopped for a quick bite to eat after being at an outdoor concert all day. You can feel an emerging sunburn already tingling the tops of your shoulders. Inside this McDonald’s it’s hot, crowded, and the tables are sticky from spilled soda and ketchup packets that haven’t been cleaned since the morning shift. You order chicken nuggets, but the order comes out wrong and is a quarter pounder instead. 

The cashier apologizes and lets you know that it will be a few minutes before a fresh batch of nuggets is ready. You scowl, snatch the bag from the cashier, and proceed to shove the hamburger and wilted, cold fries into your mouth as quickly as possible so you can retreat back to your car and get on the road. 

Now imagine that your grandma calls you up on a Saturday morning.

She asks if you’d like to meet up at McDonald’s for an egg McMuffin and coffee. Once there, you see she’s happy and has claimed a table in a quiet corner. The coffee is hot and tastes surprisingly good. Grandma reminds you of how long it’s been since you’ve had a “date” at McDonald’s together – it was a regular thing you used to do together after your middle school volleyball games. 

You laugh and spend the next hour with your grandma, reminiscing about old times you haven’t thought about in years. Before you know it, two hours have passed and it’s time to go. Grandma gives your hand a warm squeeze and says, “We should do this more often.”

Set and Setting

Clinicians often use the phrase “set and setting” when referring to the psychopharmacology of psychedelics. The phrase is simple enough, but it refers to a dizzyingly complex interplay between external and internal factors. Any single or combination of factors can influence the type of experience someone has while using a psychoactive substance.

Simply stated, Set refers to the internal factors that influence our experience. Sticking with the McDonald’s analogy, we can think of this as “what we bring to the table” or “what’s on our plate”.  Setting is the external factors that can affect our experience.

Set can be further broken down into 4 categories:

  1. Identity – this category includes your culture, family, where you are from, your, language, gender, race & ethnicity, sexual orientation, and all the unique things that make you you.

  2. Perspective – your education and credentials, who’s mentored and taught you, where you trained; the values and beliefs you hold, the worldview and type of media you consume, your philosophies and presence or absence of spirituality.

  3. Intrapersonal Development – what life experiences have you had? Have you experienced trauma? Healing? How do you care for yourself and how do you show up authentically in the world?

  4. Intention – what do you identify as your purpose in life? What are your passions? What is the reason for taking a psychedelic and what meaning do you hope to make from the experience? What drives you? How does this relate to your relationship with others in your life?

Setting includes two broad considerations:

  1. Location – Is this experience happening in a private practice? University? Is it part of a research study or is it a ceremonial experience? Is it happening outdoors or indoors? What is the business model and goal of the agency sponsoring the experience?

  2. Society and culture – Is the substance legal? What policies and procedures does the organization have in place to ensure your safety? What greater societal needs might be met by this experience and what comes out of it? Is this an accepted, mainstream practice in your community? What adjacent areas of your personal life and the broader community could be affected?

Timothy Leary is the first academic credited with using the phrase set and setting1, but the intertwining of drugs, society, and culture is well known to be a critical component of tribal and shamanic rituals for centuries. 

In modern use, healing or progress may occur with the use of a psychedelic in the setting of a clinic appointment or session. But it is important to realize this is a derived use from healing that has historically occurred within the context of ceremony and tradition. The nuanced, complex interplay between set and setting directly affects what the user and, by extension, what the community experiences.2 

Psychedelic-assisted psychotherapists carefully consider the set and setting in order to create a safe container for their clients’ work. Part of the consultation should include a preliminary overview of what perspective a patient is bringing to the work before intention-setting.

A good psychedelic-assisted psychotherapist will have also carefully considered their own set and setting and are engaged in their own ongoing development and shadow work while caring for others.


  1. Leary T (1961) Drugs, Set & Suggestibility. Paper presented at the annual meeting of the American Psychological Association, 6 September 1961.
  2. Winkelman MJ. The Evolved Psychology of Psychedelic Set and Setting: Inferences Regarding the Roles of Shamanism and Entheogenic Ecopsychology. Front Pharmacol. 2021 Feb 23;12:619890. doi: 10.3389/fphar.2021.619890. PMID: 33732156; PMCID: PMC7959790.

You might like...

About the Author

Sarah Stork Tatko is a physician assistant specializing in psychedelic assisted psychotherapy.

Her goal is to help improve the lives of people suffering from treatment-resistant depression, anxiety, OCD, PTSD, and eating disorders.

Recent Posts