Dan Siegel has defined integration as the linkage of differentiated aspects of a system (Siegel, 2012b). When a system is highly integrated, it is neither too rigid nor too chaotic, and it is therefore flexible, adaptive, and resilient.
We can think of the brain and the mind in this manner: to create healthy flexibility, adaptability, and resilience, the too rigid and too chaotic brain and mind require differentiation and linkage creating more optimal states. Essentially, integration is the re-writing or re-wiring of old, dysfunctional mental and neural patterns into newer, more flexible, and more resilient ones. To bring this about, new information must be incorporated into and linked within the system.
Integration provides the opportunity for clients to explore ongoing or emergent emotional material, make meaning of altered states, and reflect on how to make behavioural and life changes (Gorman et al., 2021; Mithoefer, 2016; Pilecki et al., 2021). In addition, the health professional can mitigate potential adverse psychological effects through assessing the client’s state post experience and with therapy. While integration can be done by the individual independently, engaging with a therapist or guide is encouraged.
We can think of the brain and the mind in this manner: to create healthy flexibility, adaptability, and resilience, the too rigid and too chaotic brain and mind require differentiation and linkage creating more optimal states. Essentially, integration is the re-writing or re-wiring of old, dysfunctional mental and neural patterns into newer, more flexible, and more resilient ones. To bring this about, new information must be incorporated into and linked within the system.
Integration provides the opportunity for clients to explore ongoing or emergent emotional material, make meaning of altered states, and reflect on how to make behavioural and life changes (Gorman et al., 2021; Mithoefer, 2016; Pilecki et al., 2021). In addition, the health professional can mitigate potential adverse psychological effects through assessing the client’s state post experience and with therapy. While integration can be done by the individual independently, engaging with a therapist or guide is encouraged.
Video: How to Integrate a Psychedelic Experience into Every-day Life
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Integration is one of the key practices that distinguishes recreational and therapeutic uses of psychedelic compounds and correlates with longer-term outcomes (Curtis et al., 2020; Phelps, 2017; Schenberg, 2018). Watch this video to learn more about some key considerations during Integration Sessions including the role of intention setting.
Integration Needs Framework
There are several important aspects to integration. What follows is a framework developed through our applied integration, clinical work, and the literature (Watts & Luoma, 2020; Wong, 2020; Woods et al., 2019). It has been derived from a variety of sources, intended to give health professionals and those working underground a structure for assessing the common client integration needs at any given stage of the integration process. The following needs framework includes the following phases.
Regulation
We can think of regulation as primarily associated with managing emotion and the nervous system. Regulating one’s emotion is a skill that can be applied prior to a potentially dysregulating situation or once emotional reactivity is already present.
Psychedelic experiences can disrupt clients’ existing resources for coping. They may help to deconstruct or loosen tightly held views and disrupt habitual ways of being that can be perceived as dysregulating or exciting, depending on the person and their circumstances. Explanations for this process may be framed in terms of the entropic brain hypothesis (Carhart-Harris, 2018). Through the use of therapeutic techniques such as ACT, Cognitive Behavioural Therapy, Motivational Interviewing, Somatic Experiencing, and Mindful Inquiry, clients may be supported to reconstruct their relationship with themselves, others, and the world around them.
Health professionals support clients’ opening, reconstructing, and embodying of the learning that arises from the altered state. This may take the form of assisting clients in developing novel cognitive, emotional, or behavioural responses that are aligned with their newly formed values and intentions. This is consistent with the committed action dimension of ACT and other third wave therapies (Walsh & Thiessen, 2018; Watts & Luoma, 2020; Wolff et al., 2020).
Normalizing
Normalizing speaks to the client’s need to make sense of their experience.
This can be an essential part of integration, particularly when they have no or little frame of reference for what they experience during and following the Medicine Session(s). Such experiences may include:
Intense emotional states
Extreme reactivity
Insomnia
Vivid dreams
Changes in relationships
Persistent changes in perception
One of the functions of integration is to provide a frame of reference for what is arising for the client. This involves normalizing the client experience, helping them to create coherence, and integrating it into their sense of self and worldview.
Metabolizing
As part of integration, metabolizing experience refers to how effectively one is able to identify, attend to, be curious, turn toward, stay with (often through somatic experience), and allow whatever arises to come and go. Metabolizing difficult experiences involves the digestion of emotions, their physical correlates, and other sensations. We might argue the more effective this process is, the greater the client’s wellbeing.
Meaning Making
Psychedelic medicines can provide a view into reality as a construct. It would seem that, because psychedelic medicines are disruptive and result in a period of neuroplasticity, they can allow for significant shifts in one’s view of self and others, leading to enhanced psychological flexibility and healing.
Deriving meaning from the psychedelic experience becomes a significant part of what is to be learned from the integration process. Meaning-making assists in optimizing the utility of the experience and is related to the client’s intentions and future wellbeing.
From a psychological flexibility model and ACT perspective, it is helpful to assist clients specifically with crystallizing clarified values as they make meaning out of their experiences. There are many ways in which we can extract meaning from an experience.
Keeping it Alive
Following the psychedelic experience, clients often report that they want to continue to stay connected and engaged with what has often been a transformative experience. Keeping it alive can include an ongoing exploration of their meaning-making and content from the session. This can allow the experience to continue to expand and transform their lives.
Some examples of keeping it alive include:
Developing new practices and rituals (such as doing yoga every day)
Gratitude practices
Creative expression
Engaging with a friend who has had similar experiences
Connection to Others
Working with psychedelic medicines or alternate states of consciousness may reveal an increased need for relationships, connection to the environment, and community. Clients can be encouraged to share their experiences with others. Often, people will want to seek out others who are exploring non-ordinary states of consciousness. The health professional may provide resources or encourage the client to seek out groups.
Relationships can also change as a result of this work. Many people often feel a desire to end certain relationships, seek new ones, or resolve something from the past with specific people.
Furthermore, connection is an important theme that commonly emerges from this work and especially connection to nature. Explore with the client ways they can engage with nature in an authentic and non-appropriating manner.
Committed Actions
Committed actions (derived from Acceptance and Commitment Therapy) are those that enable the client to behave in ways that are consistent with their new-found values and intentions.
Acting in ways that are consistent with our values can enhance motivation and allow us to engage in behaviours in the service of our mental health and wellbeing. Psychedelic sessions may reveal ways in which we are not acting consistently with our deepest values. Alternatively, they may help us to discover what these values are, and integration can be a time to explore how we may bring behavioural change into alignment with our values and intentions.
This stage is when concrete tasks may be developed collaboratively between the client and health professional to optimize the client’s desired outcomes. Developing such a behavioural plan is a way for the client to keep the work alive, continuing the learnings that have been gleaned from the psychedelic Medicine Session(s) and the application of them to everyday life.
Spiritual Needs
Commonly, clients can enter a peak or mystical state during the psychedelic Medicine Session that they then feel the need to integrate into everyday life. For some, this is extremely challenging if such an experience is discordant with their view of self and previous beliefs about spirituality. For example, someone who has grown up in a particular religion has a psychedelic induced realization that everything is sacred and not limited to the church. This new realization could be in conflict with previous beliefs.
Integration then is aimed at how clients come to terms with such a challenge and reconcile their previous beliefs with what has been perceived as profound, anomalous, and mysterious. Health professionals can conceive of this as consistent with working with any other belief or view. Should clients wish to put these new beliefs into practice, part of health professionals’ work will be to support this process in cognitive, emotional, and practical ways.
Health Professional Tip
How can you help clients prepare for Integration Sessions after their Medicine Session?
Prior to the Integration Sessions, you may provide clients with the following questions to reflect on to assist them in preparing for the integration work.
What was learned, if anything?
What are the main themes that came up from the session?
What do I notice that is different, if anything?
What might be the value of the experience as applied to my intention, values, and life going forward?
How might I actualize my intentions and what was learned through committed actions?
Looking at my schedule, how can I allocate time to reflect and be in relationship with this experience?
Are there any sensations in my body (pleasant or unpleasant) that feel new or different, or surface when I'm thinking about aspects of the session?
References
Curtis, R., Roberts, L., Graves, E., Rainey, H. T., Wynn, D., Krantz, D., & Wieloch, V. (2020). The Role of Psychedelics and Counseling in Mental Health Treatment. Journal of Mental Health Counseling, 42(4), 323-338.
Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice [Hypothesis and Theory]. Frontiers in psychology, 12(710).
Mithoefer M. (2016) A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder. http://www.maps.org/research/mdma/mdma-research-timeline/4887-a-manual-for-mdma-assisted-psychotherapy-in-the-treatment-of-ptsd
Phelps, J. (2017). Developing Guidelines and Competencies for the Training of Psychedelic Therapists. Journal of Humanistic Psychology, 57(5), 450-487.
Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm reduction journal, 18(1), 40.
Schenberg, E. E. (2018). Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. Frontiers in Pharmacology, 9(733). https://doi.org/10.3389/fphar.2018.00733
Siegel, D. (2012b). Pocket Guide To Interpersonal Neurobiology: An Intergrative Handbook Of The Mind. WW Norton.
Watts, R., & Luoma, J. B. (2020). The use of the psychological flexibility model to support psychedelic assisted therapy. Journal of Contextual Behavioral Science, 15, 92-102.
Wong, A. (2020, May). Why you can't think your way out of trauma. Psychology Today. Retrieved May 24, 2022, from https://www.psychologytoday.com/ca/blog/the-body-knows-the-way-home/202005/why-you-cant-think-your-way-out-trauma
Woods, S. L., Rockman, P., & Collins, E. (2019). Mindfulness-based cognitive therapy: Embodied presence and inquiry in practice. New Harbinger Publications.
