Start with honesty
The single most valuable thing a person can bring to a screening conversation is a complete and unflattering account of their own history. People routinely omit a psychiatric hospitalisation from a decade ago, a family member's diagnosis, a medication they take occasionally, or how much they actually drink.
Those omissions are understandable. People want to be allowed in. They are also the most common upstream cause of harm in this field, and they cannot be corrected by anyone else, because nobody else has the information.
If you find yourself editing your history in order to qualify, that is worth sitting with before anything else happens.
The medical and medication review
Get a current picture of your cardiovascular health from a doctor, particularly if you are over forty, have never been assessed, or have any family history. Bring a complete list of everything you take, prescription and otherwise, including supplements and anything occasional.
If you take a psychiatric medication, that conversation belongs with your prescriber. Do not let anyone who is not your prescriber advise you to stop it. Stopping an antidepressant carries real risks including relapse and withdrawal, and those risks are frequently minimised by people who would like you to attend. See risk, contraindications, screening.
Intention, held loosely
It helps to know why you are doing this. It also helps to accept that you may get something other than what you asked for, or nothing recognisable at all.
Useful intentions tend to be small and specific: to be able to grieve, to stop repeating one particular pattern, to see something honestly. Unhelpful intentions tend to be large and outsourced: to be fixed, to be told what to do with my life, to become someone else.
Arrange the aftercare first
Decide, before you go, who you will talk to in the first week and in the first month. If you have a therapist, tell them beforehand. If you do not, consider finding one before rather than after.
Clear the following week where you can. Do not schedule a major presentation, a difficult family event, or a flight the next morning. Arrange for someone to be reachable.
People consistently underestimate this part and consistently regret it. See integration.
The weeks beforehand
- Reduce alcohol. Reduce cannabis. Both dull the preparation and both complicate the aftermath.
- Sleep properly. It is the single largest modifiable factor in how you will cope.
- Move your body regularly, in whatever way you can sustain.
- Write. What you are hoping for, what you are afraid of, what you have avoided saying to someone. Keep it. You will want it afterwards.
- Have the difficult conversation you have been postponing. It is remarkable how often that turns out to have been the actual work.
Choosing who to trust
Reasonable questions to ask anyone offering this, and the answers you want to hear:
- What exactly am I being offered, synthetic or toad-derived, and what do you know about its composition. A specific answer, not a reassurance.
- What is your screening process, and who conducts it. Ideally not the person taking the payment.
- What is your medical backup and how far is the nearest hospital. A number, in minutes.
- What happens if I change my mind after paying. A policy, in writing.
- Who supervises you, and has anyone ever complained about you. Watch the reaction as much as the answer.
- What is your aftercare, specifically, in the month afterwards. Names and dates, not sentiment.
Anyone who becomes defensive at these questions has answered the most important one.