The Original Model
Leary’s first circuit begins with the organism’s dependence on its surroundings for nourishment, protection, and continued life. Approach and withdrawal are organized around what sustains the body and what threatens it. His infant and caregiver examples place bodily security before elaborate language or social identity: the environment is first encountered through feeding, warmth, contact, discomfort, and danger. He called the three stages bio-survival receptivity, intelligence, and fusion-synergy. Within his theory, an initially receptive organism develops discrimination and then a more organized linkage with the source of protection. (Leary, 1977)
Leary used imprinting to explain how early encounters could establish enduring orientations toward safety and threat. That is his historical mechanism. It should not be presented as a finding from contemporary attachment neuroscience, or used to infer a participant’s infancy from what happens in a session. The useful practical question is more immediate: what does this person need in order to feel, and actually be, sufficiently safe here?
Contemporary Translation
Safety includes physiological conditions, the physical environment, and the participant’s understanding of what is happening. Pain, nausea, cardiovascular sensations, changes in temperature, fatigue, and altered breathing can become unusually prominent. Fear may amplify a sensation, while a physiological disturbance may itself produce fear. A practitioner has to consider both possibilities without deciding too early that a symptom is merely anxiety or that every unfamiliar sensation signals disease. Screening and preparation require attention to medication and substance history, medical conditions, coexisting psychiatric concerns, and relevant trauma history. (Johnson et al., 2008)
The room also makes demands on the body. Noise, lighting, unfamiliar surroundings, bathroom access, the distance to a doorway, help with mobility, and the ability to change position can all affect the participant’s experience. Hydration needs belong within an appropriate clinical plan rather than an assumption that more fluid is always better. Orientation includes knowing who is present and whether the setting feels predictable and escapable. A beautifully arranged room can still feel confining to someone who does not understand its rules. The contemporary set and setting literature treats these surrounding conditions as part of the intervention, while also documenting substantial variation in how studies describe them. (Estric et al., 2025)
Before intoxication, preparation should establish the expected session length, likely physical effects, monitoring arrangements, emergency procedures, and who makes which decisions. Explain touch boundaries, options for noise and light, bathroom arrangements, movement, and the participant’s available choices. Informed consent is easier to exercise when those choices are concrete enough to imagine. A participant should not have to discover the meaning of “support” while struggling to speak or judge an unfamiliar bodily sensation. (Bradberry et al., 2024)
Two responsibilities, held together
Hear the experience
Fear, grief, meaning, and the participant’s account.
Assess the body
Symptoms, monitoring, and appropriate escalation within the practitioner’s role.
A reading aid drawn from this chapter’s practice discussion.
In Practice
A participant reports chest pressure while becoming frightened. The practitioner stays present, asks about the symptom, and follows the program’s medical assessment and escalation procedures within their role. The person may describe grief at the same time. That meaning can be heard without delaying appropriate medical evaluation; an anxious presentation does not make chest pressure a psychological diagnosis.
Another participant repeatedly asks whether the door is locked. Earlier history includes confinement, but the practitioner does not assume this explains everything. They answer the question plainly, show how the door works when appropriate, clarify the agreed boundaries around leaving, and offer a supported change of position or location if safe. Repeating a reassurance that the participant cannot verify may be less useful than restoring an understandable choice.
A participant calls repeated vomiting “purging” and says it feels emotionally necessary. The practitioner can respect that description while continuing to attend to consciousness, airway and aspiration concerns, fluid loss, medication or substance interactions, and other signs that require clinical assessment. Neither an emotional interpretation nor a ceremonial explanation cancels the responsibility to monitor the body.
The practitioner’s behavior is also part of the scene. Visible panic, hurried movement, several staff members speaking at once, or contradictory reassurance can add to the participant’s uncertainty. Calm coordination means explaining what is happening, keeping communication consistent, and obtaining help when needed. It does not mean promising that nothing is wrong before the situation has been assessed.
Evidence Boundary
Research safety guidelines, informed consent scholarship, and the systematic review of set and setting independently support careful screening, preparation, environmental planning, and response procedures. Their populations and settings differ, and they do not establish one universal protocol for every substance or service. None validates a discrete Leary circuit, his evolutionary sequence, or his imprinting mechanism. The cases above illustrate professional reasoning; they are not individualized medical instructions. (Johnson et al., 2008) (Estric et al., 2025) (Bradberry et al., 2024)