On top of the clinical supervision mentioned in the other comment, therapeutic dosage is probably much lower than the ones used to go on a trip (same is true for many other hypothetically abusable medication that is already being prescribed for a whole range of mental illnesses).
I've been reading Michael Pollan's new book on this (How to Change Your Mind - really good read, incidentally) and according to him it's actually the opposite in some of the clinical trials he looked at. In the book he describes clinical settings that involve relatively large doses of psychedelics, primarily psilocybin but also DMT and LSD, because the goal is to induce "ego death" and/or a profound or mystical experience. This tends to correlate with the type of dosage where you are basically not inhabiting your familiar reality/not aware of your body for several hours at a time.
To put that in perspective, I've probably taken psychedelics around a dozen times and only truly achieved something I would call "ego death" once (a truly fascinating and moving experience, but that's for another time!). And a lot of the people I know would take fairly low doses and do things like go to parties or walk around Central Park. By comparison, the clinical amounts Pollan is describing make it virtually impossible to move around or talk in a coherent way, let alone go out into the world.
I am guessing that by "out into the world" you mean primarily into a human-made / urban / artificial built environment with other people in it, as opposed to out into the natural world (i.e. wilderness), which I think many would argue could be the most ideal setting for the types of experiences that you're discussing.