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What a guide or sitter does, and what they leave alone

People ask what a sitter actually does in a session, and whether having one changes anything. This card sets out what surveys, one state rule set, laboratory guidelines and a trial report, and what was not located.

Published Information current to 7 November 2026Review due by 5 February 2027

Read this first. This page is education, not instructions to use. Metanoia does not supply any substance. In the United States, most of the substances discussed here are Schedule I under federal law (21 CFR 1308.11). State programs such as Oregon's and Colorado's operate under state law only, and federal law still applies. Legal status differs between countries, and none of this is legal advice. Nothing here is medical advice, and nothing here gives or recommends a dose. People who host, supply or take part in sessions involving controlled substances can face criminal liability under federal and state law. This page does not advise on that. “Healthy adults” means people with no diagnosed psychiatric or major medical condition, the population Metanoia studies. This page reports what published sources say about work done outside supervised programs, and it takes no position on the legality of any setting, practice or person.
Not an emergency resource. Metanoia is not an emergency service. In a medical emergency in the United States the number is 911, and the 988 Suicide and Crisis Lifeline is available by call or text. Elsewhere, local emergency numbers apply. Nothing on this card is a reason to delay or avoid medical care. This card describes what sources report. It is not a protocol and it does not say what to do in a hard moment.
For people using without a guide. This card reports what sources say a guide or sitter does. Sources describe a calm presence that makes sure the person feels safe and comfortable and mostly does not steer the experience. Metanoia's search on 7 November 2026 located no controlled or prospective study comparing sessions with and without a guide in healthy adults. In a 2016 survey of 1,993 adults describing their hardest mushroom experience, a guide's presence went with a shorter hard phase but not a lower degree of difficulty, and the sample chose to report a hard experience. Sessions taken alone, at home or by video are on the card alone, at home, or remotely.

The short answer

What do sources say a guide or sitter does, and does having one change anything?

Sources describe a calm presence that makes sure the person feels safe and comfortable and mostly does not steer the experience. Metanoia's search on 7 November 2026 located no controlled or prospective study comparing sessions with and without a guide in healthy adults, so none can say whether the role changes outcomes in healthy adults. One survey of people who chose to describe a hard mushroom experience compared those who had a guide with those who did not, and found an association with a shorter hard phase. This card is not a standard of care.

What do research and rules report?
  • What a provider survey reports. Of 80 respondents who sit with clients, 76.3% chose the statement that they make sure clients feel safe and comfortable but otherwise do not interfere, 66.3% chose responding encouragingly without trying to guide, and 31.3% chose actively discussing issues clients raise during the session. More than one answer could be chosen. The question concerned a session in general, not a moment of distress. The 107 practitioners came from advertisements, mailing lists and social media, and their answers could not be verified. Source 1, level 1
  • What one state requires. In Oregon's licensed psilocybin program, a facilitator must be present throughout an administration session and monitor clients in person by sight and sound for physical or emotional distress, with video not sufficient. A facilitator may not engage in conduct needing another license, such as diagnosing or treating, with a narrow exception for notified licensed professionals in preparation and integration sessions (OAR 333-333-5130(5) and (6)), and must attempt contact with each client within 72 hours. This is the text in force on 7 November 2026, and it applies in that program only. A new Oregon rulemaking with a planned effective date of 15 January 2027 may change it. Source 2, level 1
  • What laboratory and expert sources describe. The 2008 laboratory guidelines, which are expert opinion, describe two facilitators so the participant is never alone, and calm reassurance. Source 3, level 1 A 2025 consensus of 89 experts listed 30 items trials should report, including who was present. It says what to report, not what to do. Source 4, level 1
  • What was measured. In a 2016 survey of 1,993 adults describing their hardest mushroom experience, a guide's presence went with a shorter hard phase but not a lower degree of difficulty. The sample chose to report a hard experience. Source 5, level 1
  • In 20 analyzed adults with diagnosed depression in one trial, a stronger participant-rated alliance with facilitators went with lower depression scores later. This is correlation in a small group and says nothing about healthy adults. Source 6, level 1

What is not known?

“Not located” means that the searches Metanoia ran on 7 November 2026 did not return it. They covered PubMed, Europe PMC including preprint servers, and ClinicalTrials.gov. Two further papers found by a review on 8 November 2026 were read in full and are used below. Other papers named in that review, on silence in sessions and on facilitator competencies, have not been read and carry no claim. More searching could change the picture.

  • Whether a guide's presence changes outcomes in healthy adults. Not located.
  • Which tasks matter, such as silence, touch or conversation. The searches did not locate a study in healthy adults that compares such tasks against each other or tests which of them matter. One 2026 interview study of 18 participants in a psilocybin trial for generalized anxiety disorder describes how they experienced protocol-defined supportive touch, and it did not compare touch with other tasks. Source 7, level 1
  • How much facilitators shape the acute experience in healthy volunteers. Two 2026 studies bear on this, but only abstracts were accessible, so neither is used.
  • Who sits in unregulated settings, and how they are trained. Who sits in unregulated settings is not described beyond the one self-selected survey above. On training, one 2026 analysis interviewed representatives of 13 United States facilitation training programs. It describes programs that differ widely in length, content and certification, says it is not a representative survey, and notes that what graduates go on to do is not generally known. Source 8, level 1

What this card does not say

  • It does not recommend having or not having a guide, or any way to guide.
  • It does not say what to do or when to seek help in a hard moment. For what sources report on hard moments, see the card When a session gets hard.
  • Metanoia does not train, certify, supervise or supply guides.
  • Sessions taken alone, at home or by video, and one state's rules on presence, are on the card alone, at home, or remotely.
  • It does not rate how risky, safe or worthwhile any practice is.

Send a correction

If this card reports something wrongly, tell us. Write to main@metanoia-ca.org and keep the card name in the subject line. Accounts of what happened in a session belong in the field reports channel, not in email. Please leave out names and anything that identifies a person or a place. We read every message.

Where does this come from?

Grade key: 1 = peer-reviewed publication, official document or primary record. 2 = reliable secondary source. 3 = grey source (community, social media, organization pages). 4 = traditional or ethnographic source. A grade names the type of source, and the design and limits are given in the text. “Full text” means Metanoia read the body of the paper in full on the date given, and any part not read is named. A source read only in part carries no claim on this card. Sources described in the text as found and not read carry no claim and are not listed.

Review due by 5 February 2027.

  1. Glynos NG et al. Going Underground: Demographics, Services, and Best Practices Endorsed by Practitioners Providing Support for Naturalistic Psychedelic Use. J Psychoactive Drugs 2025. DOI 10.1080/02791072.2024.2405685 PMID 39297183. Grade 1. Self-report survey, convenience sample. Full text read 7 November 2026. Figures from the table for the 80 respondents who sit with clients.
  2. Or. Admin. Code 333-333-5130, 5200 and 5250, Oregon Secretary of State Administrative Rules, chapter 333, division 333. Official rules site. Grade 1. State rule text. The three rules were read in full on 7 November 2026 on the official site. Also read: the Oregon Health Authority notice of proposed rulemaking filed 28 August 2026, which amends all three rules and leaves continuous monitoring and the 72-hour contact unchanged. The agency's rulemaking page of 7 November 2026 says it will not file final rules from that process and has a new rulemaking under way with a planned effective date of 15 January 2027.
  3. Johnson MW, Richards WA, Griffiths RR. Human hallucinogen research: guidelines for safety. J Psychopharmacol 2008. DOI 10.1177/0269881108093587 PMID 18593734. Grade 1. Expert guidelines for laboratory research, which are opinion and not a trial. Full text read 3 November 2026, the passages cited re-checked 7 November 2026.
  4. Pronovost-Morgan C et al. An international Delphi consensus for reporting of setting in psychedelic clinical trials. Nat Med 2025. DOI 10.1038/s41591-025-03685-9 PMID 40461819. Grade 1. Delphi consensus. Full text read 7 November 2026 (supplements not read).
  5. Carbonaro TM et al. Survey study of challenging experiences after ingesting psilocybin mushrooms. J Psychopharmacol 2016. DOI 10.1177/0269881116662634 PMID 27578767. Grade 1. Online survey of 1,993 people. Full text read in full 7 November 2026 (figures not read). Self-selected sample, so the rates are not population rates (the authors say so).
  6. Levin AW et al. The therapeutic alliance between study participants and intervention facilitators is associated with acute effects and clinical outcomes in a psilocybin-assisted therapy trial for major depressive disorder. PLoS One 2024. DOI 10.1371/journal.pone.0300501 PMID 38483940. Grade 1. Secondary analysis of a trial. Full text read 7 November 2026 (supplements not read). The authors note a self-referred sample and possible expectancy bias.
  7. Ham R, Gardner J, Carter A, Liknaitzky P. Participant Experiences of Therapeutic Touch in Psilocybin-Assisted Therapy. Brain Behav 2026, 16(2):e71262. DOI 10.1002/brb3.71262 PMID 41699875. Grade 1. Qualitative interviews, 39 interviews with 18 participants from one trial in people with generalized anxiety disorder. Full text read 8 November 2026 (supplementary table not read). The interviews were selected for depth of description, and the authors say the findings are specific to psilocybin.
  8. Palitsky R, Peacock C, Breau JA, Gillis-Smith P, Sklodowska G. A landscape analysis of psychedelic facilitation training in the US. PLoS One 2026, 21(5):e0350037. DOI 10.1371/journal.pone.0350037 PMID 42213666. Grade 1. Quality improvement interviews with 13 training organizations, interview notes confirmed by interviewees. Full text read 8 November 2026 (interview guide in the supplement not read). The authors say it is not a representative survey and that frequencies of endorsement are not rates.