Walking into a clinic for your first psychedelic-assisted therapy session can feel like stepping into the unknown — even after weeks of preparation, written consent, and reading every available patient resource. The most common question patients ask in the days before their first dose isn't about the molecule. It's about the day itself: what time to arrive, what to wear, who will be in the room, when the medicine takes effect, what the team does if something feels overwhelming, and when they can finally sleep in their own bed. This guide walks through a first session in the order it actually happens, across the four modalities currently available in Canada — ketamine (off-label), Spravato / esketamine (Health Canada approved for treatment-resistant depression), psilocybin (SAP-only), and MDMA-assisted therapy (SAP-only). Each substance has its own rhythm; the surrounding clinical structure is broadly similar.

Key takeaways

Plan for a full clinical day. Ketamine IV runs 40–60 minutes plus observation; Spravato includes a 2-hour mandatory in-clinic observation; psilocybin and MDMA-AT sessions are 6–8 hours total.

Vitals are checked at arrival, during the session, and before discharge — heart rate, blood pressure, and (for some protocols) weight and oxygen saturation.

You will not drive home, no exceptions. All four modalities require a designated driver and a 24-hour no-driving rule.

Two-clinician model is standard for psilocybin and MDMA-AT per the published Phase 2/3 protocols (Goodwin 2022; Mitchell 2021/2023). Ketamine and Spravato staffing varies by clinic.

An integration appointment is typically scheduled within 24–72 hours of dosing day.

No major decisions, no heavy machinery, no alcohol or recreational substances for at least 24–72 hours after dosing.

Every patient's experience is unique. The team is trained to support what arises — not to manufacture a specific outcome.

Before the day — the 24 hours leading up to your session

Most of the work that makes a dosing day go smoothly happens in the day before, not in the morning of.

Medication considerations

Your prescribing physician will have given you specific guidance about which of your regular medications to take, hold, or adjust on the day of your session. Common medication considerations across modalities:

SSRIs and SNRIs: For psilocybin and MDMA-AT, antidepressants are often tapered and held in advance under prescriber supervision (because they blunt the effect of classic psychedelics and, in the case of MDMA, raise the risk of serotonin syndrome). For ketamine and Spravato, SSRIs are typically continued.
Benzodiazepines: Held on dosing day for psilocybin and MDMA-AT (they blunt the experience and reduce therapeutic engagement). Ketamine and Spravato protocols vary.
MAOIs: Absolute exclusion for MDMA-AT — washout completed weeks in advance.
Stimulants (e.g., methylphenidate): Typically held on dosing day across all four modalities.
Blood pressure and cardiac medications: Usually continued — your prescriber will confirm.
Lithium: Held in advance for ketamine, Spravato, psilocybin, and MDMA — drug-interaction risk.

Never adjust your own medications. Always follow the written instructions from your prescriber.

Fasting and food

Ketamine IV / IM: Light food earlier in the day; many clinics ask for 2–4 hours nothing-by-mouth before infusion to reduce nausea risk.
Spravato intranasal: Health Canada product monograph recommends no food for 2 hours and no liquids for 30 minutes before administration to minimize nausea.
Psilocybin SAP: Light breakfast or fasting morning of, per protocol — nausea is common during onset.
MDMA-AT SAP: Light meal evening before; light breakfast morning of.

Sleep, alcohol, substances

Avoid alcohol, cannabis, and recreational substances for at least 24 hours before — longer for some protocols.
Sleep well the night before. Caffeine the morning of is generally fine but avoid excess.
Hydrate — but moderately, not excessively (especially for MDMA, given hyponatremia risk).

Arrival timing

Plan to arrive 15–30 minutes early to allow for parking, check-in, vitals, and final review without rushing. Bring identification and your appointment confirmation.

What to bring

Loose, comfortable clothing you can lie down in for several hours — layered, since body temperature can shift
An eye mask for psilocybin sessions; optional for MDMA-AT (most patients keep eyes open or shifting); rarely used for ketamine or Spravato
A pre-discussed music or playlist preference if your clinic accommodates this — some protocols use a fixed clinical playlist
A water bottle (electrolyte-balanced often provided)
A journal for post-session notes
A small meaningful object if you find that grounding — a photo, a stone, a piece of jewellery
A change of clothes for after the session if you want to feel fresh leaving
Your designated driver's contact information, confirmed and arranged

Arrival and check-in

You arrive at the clinic. Standard elements of the first ~15–30 minutes:

Check-in at reception, identification, confirmation of designated driver
Brief washroom break before settling in
Confirmation of medication compliance (what you took, what you held)
Confirmation of fasting status if applicable
Final consent review — including the off-label framing for ketamine and the SAP framing for psilocybin or MDMA, expected effects, known risks, withdrawal of consent at any time

The waiting time before being taken to the dosing room is typically short. Some clinics use this period for a final brief grounding exercise with the therapy team.

Vital signs

Before any substance is administered, vital signs are taken:

Blood pressure (often both arms, especially for MDMA-AT given pronounced sympathomimetic effects)
Heart rate
Oxygen saturation (often)
Weight (used to confirm dose calculation, especially for ketamine which is often weight-based)
Temperature (for some protocols, particularly MDMA-AT given body-temperature-elevation risk)
ECG if not already on file and your protocol requires it

If any vital sign is outside the protocol's acceptable range, the session may be postponed. This is rare but not unheard of — sustained elevated blood pressure, tachycardia, or fever can each be reasons to reschedule.

Pre-session brief with the team

Once vitals are stable, you meet with the clinical team for a pre-session brief. This is not new therapy work — it's a settling-in conversation. Standard elements:

Reconnection with the team — re-establishing the therapeutic relationship built during preparation sessions
Brief check on your current emotional state — how you arrived, what you're carrying into the room today
Review of your intentions — these were articulated in preparation; today you simply confirm them
Practical orientation — the room layout, where you'll lie down, where the team will sit, where the bathroom is, how to signal if you want to pause or speak
Final questions answered

This conversation typically lasts 15–30 minutes. Its purpose is to ground you in the room with the team before the substance begins to act.

Setting up the space

You move to the dosing room. Most psychedelic-assisted therapy rooms are intentionally curated to feel more like a comfortable living space than a clinical setting:

A reclining couch, day bed, or zero-gravity chair — where you'll spend most of the session
Soft lighting — dimmable, often warm-toned; daylight typically softened with curtains
Music speakers with a curated clinical playlist queued
An eye mask available (used predominantly for psilocybin)
A blanket within reach
A small table with water, tissues, and a basin (for nausea, particularly relevant for psilocybin)
Seating for the support team at a respectful distance — close enough to support, not so close as to feel surveilled
Vital-signs equipment discreetly available (BP cuff, pulse oximeter, monitoring as protocol requires)

You settle into the dosing position. Some patients change into more comfortable clothing now if they prefer. The team helps with blanket, pillow placement, and music adjustment.

Substance administration — what differs by modality

This is where the four modalities diverge most clearly. Your specific protocol will have been agreed at intake.

Ketamine IV infusion

A small IV cannula is placed (usually in the forearm). The infusion is typically 0.5 mg/kg over 40 minutes, though weight-based dosing and protocol vary by clinic per the Cohen 2018 consensus guidelines. Onset is within minutes once the infusion begins. The infusion runs for 40–60 minutes total; effects fade within ~30 minutes after infusion ends. Total clinic time is typically 90–120 minutes.

Ketamine IM (intramuscular) or SL (sublingual)

Less common in clinic settings but used in some protocols.

IM: A single injection; onset within 5–10 minutes; experience lasts 60–90 minutes.
SL (sublingual lozenge or troche): Held in the mouth for 10–15 minutes, then swallowed; onset 10–15 minutes; experience lasts 60–90 minutes.

Spravato (esketamine intranasal)

Spravato is a Health Canada–approved intranasal medication for treatment-resistant depression, administered with a single-use nasal device. The product monograph requires:

Dose: typically 56 mg or 84 mg (two or three device sprays, alternating nostrils, with rest intervals)
Self-administration under direct clinical supervision — you spray, the team observes
Mandatory 2-hour in-clinic observation after the final spray, with monitoring of blood pressure, sedation level, and dissociation
No driving until the day after the session, regardless of how alert you feel

Psilocybin SAP oral

For SAP-pathway psilocybin therapy, the standard adult oral dose used in most published protocols (Goodwin 2022 COMP001) is 25 mg synthetic psilocybin, administered in capsule form with water. Onset is 20–60 minutes. Peak intensity is around 2–3 hours. The full experience window is 6–8 hours, with most patients eligible for discharge by hour 7–8.

MDMA-AT SAP

For SAP-pathway MDMA-AT (per the Mitchell 2021/2023 MAPP1/MAPP2 Phase 3 protocols), administration is oral:

Initial dose: 80 mg (or 120 mg in some protocols)
Optional supplemental dose: 40 mg (or 60 mg) approximately 90 minutes after the initial dose, if appropriate per protocol
Onset 30–60 minutes; peak 1.5–3 hours; experience window 6–8 hours.

During the session — what's typical

Once the medicine begins to act, the experience differs by substance, but several themes are common across all four.

Common across modalities

Perceptual changes: visual texture, colour intensity, sound depth, or sense of body position may shift. Classic psychedelics (psilocybin) produce the most pronounced perceptual changes; MDMA produces the mildest; ketamine produces dissociative rather than psychedelic shifts.
Emotional surfacing: feelings, memories, or images may arise spontaneously. This is therapeutic, not a malfunction.
Time distortion: minutes can feel like hours. This resolves as the substance wears off.
Body sensations: warmth, tingling, weight, lightness, sometimes heaviness in chest or abdomen.

"Set" considerations

The team will encourage an inward orientation — eyes closed (with mask for psilocybin), focused on the music, allowing whatever arises to arise. The phrase used in published protocols is "trust, let go, be open." You don't have to chase an experience or steer it.

Therapist presence by modality

Ketamine and Spravato: Generally one clinical staff member (RN, RPN, or physician) monitoring; therapeutic conversation is typically minimal during the experience and concentrated in adjacent therapy sessions.
Psilocybin SAP: Two-clinician model per the COMP001 protocol — one lead therapist, one co-therapist, both present and predominantly quiet, available if you want to speak or need support.
MDMA-AT SAP: Two-clinician model per the Mitchell 2021/2023 protocols — both therapists are present and actively engaged in conversation during the peak, supporting trauma-focused therapeutic work in real time.

Common challenging experiences

Difficult moments can happen in any session. They are not signs that something has gone wrong — they are part of the therapeutic frame, and the team is trained to support you through them.

Acute anxiety: A wave of fear or overwhelm, often early in onset. Response: grounding (feet on floor, hand on chest), reassurance, slowed breath. Rarely, a benzodiazepine rescue may be administered if distress is severe and persistent.
Nausea: Particularly common with oral psilocybin and during MDMA onset. A basin is within reach; ondansetron or similar antiemetic may be available per protocol.
Intense emotion: Tears, grief, anger, or memory surfacing. Response: the team stays close, validates, and supports without redirecting.
Feeling "stuck" in a difficult experience: Less common but possible. Response: change of music, eye-mask removal, gentle conversation, sometimes a brief sit-up or a sip of water.
Cardiovascular sensations: Mild chest tightness or awareness of heart rate is common with MDMA. The team monitors continuously and intervenes if vitals leave protocol range.

The team's role is to support what is arising, not to suppress it. Most challenging experiences resolve within minutes when met with steady presence.

Vital signs monitoring throughout

Vitals are re-checked during the session at protocol-specified intervals:

Ketamine IV: Continuous or near-continuous BP and SpO2 monitoring during infusion.
Spravato: BP at baseline, 40 minutes, and at end of the 2-hour observation.
Psilocybin SAP: BP and HR at baseline and approximately every 30–60 minutes during the experience window.
MDMA-AT SAP: BP, HR, and body temperature at baseline and at multiple points during the session — cardiovascular monitoring is the most intensive across modalities.

If a vital sign moves outside protocol range, the team has predefined responses — repositioning, hydration, brief cooling for MDMA, or, rarely, antihypertensive medication.

Post-session: gradual emergence and brief debrief

As the substance wears off, you re-emerge gradually. The team supports this transition:

Lights are gently raised; music transitions to a quieter playlist
You move slowly — sit up, sip water, perhaps eat a small snack
A brief debrief captures initial impressions: what arose, what felt important, what was unexpected. This is not full integration — that happens in a dedicated session 24–72 hours later.
Final vital signs are checked
Confirmation of stable mental status: oriented, communicative, not acutely distressed

Discharge readiness is a clinical decision, not a clock decision. You leave when the team confirms you are safe to be released to your support person.

The 24-hour no-driving rule

You cannot drive yourself home after any of these sessions, regardless of how alert you feel. Residual effects on perception, judgment, and reaction time persist for hours and can be subtle.

Ketamine and Spravato: No driving until the next day.
Psilocybin and MDMA: No driving for at least 24 hours; some protocols extend longer.

Your designated driver must be confirmed before the session begins. Public transit alone is not appropriate. Rideshare alone is generally not appropriate either — the published protocols and Health Canada Spravato monograph specify a known support person.

Aftercare planning

Standard aftercare across modalities:

Designated driver to home
Support person available for the rest of the day
Rest: light food, hydration, quiet activity. Many patients journal, listen to music, or watch nature.
Avoid screens / news / social media if you find them activating
Sleep well — some patients sleep deeply that night; others may have lighter, vivid sleep
Integration session within 24–72 hours — this is where the experience is processed therapeutically and where lasting change is consolidated

For the integration framework, see Integration Phase: How to Integrate a Psychedelic Therapy Experience.

What NOT to do post-session

No driving for at least 24 hours (or until your protocol says otherwise)
No operating heavy machinery for at least 24 hours
No major decisions — relationship, career, financial — for 24–72 hours, ideally until after the first integration session
No alcohol or recreational substances for at least 24 hours; longer for psilocybin and MDMA per most published guidance
No intensive exercise for 24–48 hours, particularly after MDMA-AT
No new medication starts without coordinating with your prescriber

These constraints exist because you may feel clear-headed before you fully are.

Who's in the room — staffing model summary

Modality	Clinical staffing	Therapeutic engagement during session
Ketamine IV/IM/SL	RN or physician (often single staff)	Minimal during; therapy is adjacent
Spravato intranasal	RN or physician (single staff is common)	Minimal during; therapy is adjacent
Psilocybin SAP	Two-clinician model (lead + co-therapist)	Predominantly quiet, available if needed
MDMA-AT SAP	Two-clinician model (lead + co-therapist)	Actively engaged in conversation during peak

The two-clinician model for psilocybin and MDMA-AT is drawn directly from the Phase 2/3 RCT protocols (Goodwin 2022; Mitchell 2021/2023). Ketamine and Spravato staffing reflects the shorter, more medical character of those sessions; therapeutic work for ketamine programs is concentrated in dedicated preparation and integration sessions before and after.

Substance-specific differences at a glance

Element	Ketamine IV	Spravato	Psilocybin SAP	MDMA-AT SAP
Route	IV (or IM/SL)	Intranasal	Oral capsule	Oral capsule
Typical first dose	0.5 mg/kg	56 or 84 mg	25 mg	80–120 mg + optional 40–60 mg booster
Onset	Minutes	5–15 min	20–60 min	30–60 min
Peak	During infusion	~40 min	2–3 hr	1.5–3 hr
Total experience	40–60 min	90 min + 2-hr obs	6–8 hr	6–8 hr
Total clinic time	90–120 min	~3 hr	6–8 hr	6–8 hr
Eye mask	Rarely	Rarely	Standard	Optional
Driver home	Required	Required	Required	Required
24-hr no-driving	Yes	Yes (until next day)	Yes (often longer)	Yes
Integration timing	24–72 hr	24–72 hr	24–72 hr	24–72 hr

Frequently asked questions

How early should I arrive? 15–30 minutes before your scheduled time. This buffers parking, check-in, vitals, and a final brief.

Can I bring my partner or a support person into the room? Most published protocols use therapy-team-only support during dosing. Your support person typically waits in the clinic or returns to drive you home. Discuss specifics at intake.

What if I need the bathroom during the session? The team will assist. Bathrooms are within or adjacent to the dosing room and bathroom breaks are standard, particularly for the longer psilocybin and MDMA sessions.

What if I want to stop the session? You can withdraw consent at any time. For ketamine IV, the infusion can be stopped (effects fade within ~30 minutes). For Spravato, no further sprays are administered. For oral psilocybin or MDMA, the substance is already in your system — the team supports you through, with rescue medications available if needed.

Will I remember the experience? Most patients remember significant portions; some experiences feel dreamlike or fragmented. Ketamine in particular can produce dissociative experiences with patchy recall. Integration sessions help capture and structure what surfaced.

What if I have a difficult experience? The team is trained for this. Difficult content during a session is often where the therapeutic work is happening. Integration sessions process challenging material.

Do I need to fast? Modality-dependent. Spravato has the strictest pre-session intake limits. Ketamine IV is typically 2–4 hours nothing-by-mouth. Psilocybin and MDMA are typically light meal evening before, light or no breakfast morning of.

Will I be naked, asked to remove clothing, or touched? You remain clothed. Touch in published psilocybin and MDMA-AT protocols is limited to consented, brief, supportive contact (e.g., hand on shoulder). All touch is discussed during preparation, with clear opt-out.

Can I take my own music? Some clinics accommodate; many use a curated clinical playlist designed for the dosing arc. Discuss with your team during preparation.

When is my first integration session? Typically scheduled within 24–72 hours of the dosing day, before you leave clinic on the dosing day or at the latest at discharge.

What if my vitals are out of range when I arrive? The session may be postponed. This is rare but does happen — and is handled supportively, not punitively.

Sources

Mitchell JM, et al. (2021). MDMA-assisted therapy for severe PTSD: MAPP1 Phase 3. Nat Med. https://pubmed.ncbi.nlm.nih.gov/33972795/
Mitchell JM, et al. (2023). MDMA-assisted therapy for moderate to severe PTSD: MAPP2 Phase 3. Nat Med. https://pubmed.ncbi.nlm.nih.gov/37709999/
Goodwin GM, et al. (2022). Single-dose psilocybin for treatment-resistant depression (COMP001). N Engl J Med. https://pubmed.ncbi.nlm.nih.gov/36322843/
Cohen SP, et al. (2018). Consensus guidelines on the use of intravenous ketamine infusions for chronic pain / psychiatric indications. Reg Anesth Pain Med.
Health Canada — Spravato (esketamine) Product Monograph (intranasal protocol; dosing; observation requirements).
Health Canada — SAP psychedelic-assisted psychotherapy: https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/requests-special-access-program-psychedelic-assisted-psychotherapy.html
Government of Canada — 9-8-8 Suicide Crisis Helpline: https://988.ca/

Last updated: 2026-05-06

What to Expect at Your First Psychedelic-Assisted Therapy Session