Integration Needs Framework

Regulation

We can think of regulation as primarily associated with managing emotion and the nervous system. Down-regulation refers to reducing the intensity of activated states, while up-regulation may be necessary when more energy (nervous system arousal) is required. Regulating one’s emotion is a skill that can be applied prior to a potentially dysregulating situation, or once emotional reactivity is already present. Several strategies can be used to manage dysregulation, and these include but are not limited to:

• Orienting mindful attention to the environment
• Orienting mindful attention to pleasant or neutral bodily sensations
• Working with the breath, rhythmic, or other movement
• Acceptance of what is present
• Re-directing one’s attention
• Re-appraisal or changing the situation

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 session(s). Such experiences may include:

• Intense emotional states
• Extreme reactivity
• Insomnia
• Vivid dreams
• Changes in relationships
• Persistent changes in perception
• And more

One of the functions of the health professional guiding 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 integrate it into their sense of self and worldview. For many, psychedelics involve stepping into a new world, and it is essential that there be some context setting for, and translation of, the experience as part of its integration. This is where psychoeducation for the client, experience of the health professional, and knowledge of the medicines and their range of effects can be essential.

Metabolizing

Drawing a parallel with the chemical process of metabolism, metabolizing is either anabolic or catabolic which ultimately provides energy for cellular processes. How one works with difficult experiences can be viewed as a process of metabolizing, as 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. As part of integration, metabolizing experience refers to how effectively one can:

• Identify
• Attend to
• Be curious
• Turn toward
• Stay with (often through somatic experience)
• Allow whatever arises to come and go

When unable to do that, this can be recognized and determine what needs to change, if anything, and how. Alternatively, one may be able to choose to be with things just as they are. This process is active and, at the same time, requires discernment around what is the most helpful response. Psychedelic experiences can be considered metabolized when the client has established a different relationship with, or perspective about, what has arisen. If needed, they have processed challenges or have moved into meaning-making or recognition of how their new understanding may be applied to daily life.

Meaning Making

Human beings are meaning-makers. This is how we make sense of life and our intrapersonal and interpersonal experiences. It is also inextricably tied to the development of an enduring sense of self. Meaning making consists of interpretations, conclusions, ideas, narratives, appraisals, and reappraisals of events. It can help change unhelpful views or shift beliefs, values, and goals. Meaning making can also reinforce unhelpful views dependent upon the experiences and how these are interpreted. Loosening from our identification with our beliefs about ourselves, others, and the world regardless of whether they are seen as positive or negative can enhance well-being.

Psychedelics can provide a view of reality as a construct. Because psychedelics 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. Meaning making also assists in optimizing the utility of the psychedelic experience and is related to the client’s intentions, values, and future wellbeing. There are many ways in which we can extract meaning from an experience. These may include:

• Making associations with other relevant experiences
• Interpretations elicited from the client related to their intentions
• Unpacking psychedelic material as metaphors and exploring other possible interpretations
• Bringing mindful awareness to body sensations, tracking changes, and allowing space for meaning to arise directly from present moment felt experience (this can be helpful when clients are confused or have conflicting mental interpretations, with the body centered as a source of direct authentic experience)
• Eliciting the potential benefit of a difficult experience
• Re-appraising, re-framing, identifying alternative, more helpful perspectives
• Asking the client what the experience might mean about them or their situation
• Asking what the utility of this experience might be to staying well
• Exploring how the psychedelic experience and potential learning may be consistent with the client’s values

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. This includes an ongoing exploration of their meaning-making and content from the session, as well as continuing to work with one’s reality as a construct. This can allow the experience to continue to expand, transform their lives and assist with loosening from a rigid identification with the self. Some ways of continuing to process the experience and learn from it include:

• Developing new practices and rituals (yoga, meditation, time in nature, visualizing a resourcing moment from their experience when they wake up in the morning etc.)
• Carving out time for reflection (scheduling time)
• Exploring meaning making and its effects in their day-to-day lives (journaling)
• Creative expression: such as art, writing, and music
• Gratitude practices
• Identifying an object that represents what has been important and using it as a touchstone
• Engaging with a friend through bi-weekly meetings or calls who has had similar experiences
• Continuing to engage in an exploration of the components of experience as events that come and go – sensations, thoughts, emotions, behaviours

Connection to Others

Working with psychedelics or other altered states may reveal an increased need for relationships, connection to the environment, and community. There are different elements to consider regarding connection. Listed below are some examples:

• Sharing the experience - encourage clients to share with others. They can contemplate who needs to know, who wants to know, who shouldn’t know, and most importantly with whom they feel called to share.
• Relationships can change as a result of this work. Many people often feel a desire to end certain relationships, seek new relationships, or resolve something from the past with specific people. Supporting the client through this process can be an important part of integration. Such change can bring both gain and loss.
• Community - often people will want to seek out others who are exploring altered states. The health professional may provide resources or encourage the client to seek out groups.
• Environment - 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 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 Medicine 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 is a stage when concrete tasks may be developed collaboratively between the client and the 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 Sessions and the application of them to everyday life.

Some of the ways of working with committed actions:

• Delineating important values to the client that have become salient from the sessions
• Establishing concrete goals and tasks derived from intentions and the assisted session (ensure they are manageable)
• Ensuring these tasks are consistent with stated, relevant values
• Determine behaviours that move the client away from their intentions and values
• Supporting the client to move towards behaviors that are consistent with their intentions and values
• Describing behaviours as concrete positive actions, rather than “not doing” old actions they wish to change
• Eliciting what is motivating for the client to increase the likelihood of intended behaviours occurring

Spiritual Needs

People undertake psychedelic use for a multitude of reasons. One of these may be identified as a need for meaning or connection. We can think of this as a spiritual need. In addition, given that the psychedelic experience is often so unusual and commonly consists of an experience the person has never had, they may frame it in terms of a spiritual event or crisis. The word spiritual has different meanings for different people. It may be defined within a religious context, concerned with what one considers sacred. It may be tied to seeking a purpose or meaning in life that is greater than the mundane aspects of being human. It may relate to themes of life and death, and one’s relationship to death. For others, it may be linked to the idea of awakening or liberation, freedom from suffering or being attached to worldly things.

The health professional guiding integration needs to ensure that they are aware of their own biases, beliefs, or spiritual orientations and that they are able to be unbiased towards those that are different from their own. In addition, it is important that they do not impose their own beliefs or opinions onto the client. Given the increased suggestibility of people during and following psychedelic experiences, it is important to uphold their right to freedom of thought and religion.

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. Integration then is aimed at how the client comes to terms with such a challenge and reconciles their previous beliefs with what has been perceived as profound, anomalous, and mysterious. The health professional can conceive of this as consistent with working with any other belief or view. Should the client wish to put these new beliefs into practice, part of the health professional’s work will be to support this process in cognitive, emotional, and practical ways.

When a client raises spiritual concerns, it can be useful to elicit from them what this means to them. Questions to consider are:

• When you think about the word spiritual what comes up for you?
• How would you define it?
• What would it look like if you were living a life that was more spiritual?
• How would you know?
• What would be different about how you might be living?
• What brings you closer to your spirituality? What distances you from it?