28 June 2024
The Cultural Importance of Setting in Psychedelic Therapy
by Monnica T. Williams, PhD & Zoe Jahn, BA
MAPS Bulletin: Volume XXXIV Number 1 • 2024
Introduction
It has been observed that set and setting are integral components of the psychedelic experience. Set refers to an individual’s mindset, encompassing their psychological state, intentions, and expectations. Setting, on the other hand, pertains to the physical and social environment in which the psychedelic experience occurs. With roots in diverse cultural practices, the importance of these factors is increasingly recognized in contemporary therapeutic contexts. Both set and setting significantly shape the nature and outcomes of psychedelic therapy sessions, which are in turn shaped by culture (Fogg et al., 2021).
Setting includes, but is not limited to:
- The physical therapeutic environment (e.g. treatment space)
- Music that is played during the psychedelic therapy
- The clinicians facilitating the psychedelic journey
Here we review the significance of the setting, with a specific focus on cultural considerations.
Cultural Considerations in the Therapeutic Environment
Careful attention should be given to the setting in which psychedelic therapy and research are conducted. Recognizing the diversity of participants, clinicians must be mindful of cultural nuances in décor, artwork, and overall ambiance. Consider that decor can communicate inclusion or threat. Deliberate efforts to promote diversity within the setting communicate a sense of safety and belonging among all involved.
The treatment room will ideally be adorned with culturally diverse artwork and other items, reflecting the team’s commitment to inclusivity. Williams, Reed, and Aggarwal (2020) describe their work to create a multicultural space in a study of MDMA-assisted psychotherapy for PTSD at the University of Connecticut Health Center. The study room featured framed artwork such as an image of a Latina mother and an impressionist world map. Other cultural decorations included jade beads, a Tibetan sound bowl, and colorful textiles from India. Beyond décor, the setting also encompassed cultural authenticity as these items reflected the actual cultures of the practitioners involved, highlighting the importance of a well-rounded team.
Conversely, when MAPS conducted a training for therapists of color at the historic Brown Hotel, in Louisville, Kentucky, there were decorations in the hotel that felt threatening to several Black participants. For example, the artwork depicted colonial-era White people in elegant clothing without people of color included. There was one painting of a hunting expedition that included many White men on horseback, with guns and dogs, that participants asked to have removed from the venue as it was reminiscent of hunting for runaway Black slaves. These sorts of depictions can be described as environmental microaggressions, symbols in the environment that reinforce racial hierarchies (Williams et al., 2021).
The Role of Music in Psychedelic Therapy
Music has long been intertwined with psychedelic therapy, serving as a supportive tool to guide and enhance the therapeutic process. Research indicates that music can evoke a wide range of emotions and experiences, from transcendence to nostalgia. However, the choice of music must be culturally relevant and sensitive to the diverse backgrounds of participants.
There has been a misperception that if music is wordless that means it is culture-free. As such, classical music is a common choice for psychedelic-assisted therapy sessions. Classical music, rooted in European tradition, is not culture-free, and it may not effectively support psychedelic healing for individuals from different cultural backgrounds. Instead, playlists must be thoughtfully catered to the individual preferences and cultural backgrounds of each participant, ensuring a personalized and enriching experience. It’s important to explore alternatives beyond the typical fare like new age, ambient, folk, or post-rock music (Williams, Reed, & Aggarwal, 2020). Instead, consider jazz, nature sounds, Latin tunes, drumming, and Indian music.
The Therapists
The treatment team must also be considered as an important part of the setting. Including staff members from a variety of ethnic backgrounds is essential for effectively recruiting and retaining people of color in mental health research and treatment. Participants of color feel more secure and understood when engaging with therapists of color, thereby enhancing treatment effectiveness and the relevance of the study. At UConn, a deliberately diverse team, embracing various ethnicities, sexual identities, and other dimensions, facilitated successful client engagement and therapeutic outcomes across intersecting identities (Williams, Reed, & Aggarwal, 2020).
Cultural sensitivity is essential for creating a therapeutic setting conducive to healing. The psychedelic field is experiencing increased diversity in both participant demographics and the cultural traditions being studied, emphasizing the need for researchers and clinicians to increase their level of cultural awareness and knowledge. Clinicians must be able to acknowledge and respect the unique cultural contexts of all ethnic and racial groups, particularly indigenous communities with longstanding traditions involving psychedelic medicines. (Williams, Cabral, & Faber, in press).
Conclusion
Setting plays a pivotal role in shaping the psychedelic experience, influencing outcomes and therapeutic efficacy. While strides have been made in understanding the importance of set and setting in psychedelic therapy, challenges remain, particularly concerning cultural adaptation of approaches and protocols. Empirical studies of the differential effect of music in psychedelic therapy with diverse populations are lacking, highlighting the need for further investigation and innovation in therapeutic practices.
By embracing cultural sensitivity and personalized interventions, clinicians can create environments that promote healing and transformation for individuals from all backgrounds. As psychedelic therapy continues to evolve, ongoing attention to set and setting will be essential in maximizing therapeutic benefits and promoting inclusivity.
Resources and References
Resources
Dames, S., Penn, A., Williams, M., Zamaria, J., Vaz, A., & Rousmaniere, T. (2024). Deliberate Practice in Psychedelic-Assisted Therapy. Washington DC: American Psychological Association. ISBN: 978-1-4338-4171-2
References
George, J. R., Michaels, T. I., Sevelius, J., & Williams, M. T. (2020). The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion. Journal of Psychedelic Studies, 4(1), 4-15. https://doi.org/10.1556/2054.2019.015
Fogg, C., Michaels, T. I., de la Salle, S., Jahn, Z. W., & Williams, M. T. (2021). Ethnoracial health disparities and the ethnopsychopharmacology of psychedelic medicine. Experimental and Clinical Psychopharmacology, 29(5), 539–554. https://doi.org/10.1037/pha0000490
Neitzke-Spruill, L. (2020). Race as a component of set and setting: How experiences of race can influence psychedelic experiences. Journal of Psychedelic Studies, 4(1), 51-60.
Williams, M. T., Cabral, V., & Faber, S. C. (in press). Psychedelics and racial justice. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-023-01160-5
Williams, M., Faber, S. C., & Duniya, C. (2022). Being an anti-racist clinician. The Cognitive Behaviour Therapist, 15(e19), 1-22. https://doi.org/10.1017/S1754470X22000162
Williams, M. T., Reed, S., & Aggarwal, R. (2020). Culturally-informed research design issues in a study for MDMA-assisted psychotherapy for posttraumatic stress disorder. Journal of Psychedelic Studies, 4(1), 40–50. https://doi.org/10.1556/2054.2019.016
Williams, M. T., Reed, S., & George, J. (2020). Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists. Journal of Psychedelic Studies, 4(3), 125-138. https://doi.org/10.1556/2054.2020.00137
Williams, M. T., Skinta, M. D., & Martin-Willett, R. (2021). After Pierce and Sue: Evidence for a revised racial microaggressions taxonomy. Perspectives on Psychological Science, 16(5), 991-1007. https://doi.org/10.1177/1745691621994247
Monnica T. Williams, PhD
Dr. Monnica T. Williams is a board-certified clinical psychologist and Professor at the University of Ottawa in the School of Psychology, where she serves as the Canada Research Chair for Mental Health Disparities. She is also the clinical director of the Behavioral Wellness Clinics, where she supervises a team of clinicians and doctoral students treating anxiety-related conditions and provides ketamine-assisted therapy.
Zoe Jahn Solis
Zoe Jahn Solis is a student researcher in the field of psychobiology. Zoe completed her undergraduate studies at the University of Connecticut in Biology with a minor in Physiology and Neurobiology. She is certified in Basic Life Support and as a Medical Assistant.
