PHRI is both client-centered and client-directed, while also remaining relationship-centered. The health professional embodies the attitudinal foundations discussed in the integration section during inquiry process.
Guiding by following the client’s lead, they prioritize the quality of the therapeutic relationship, while simultaneously ensuring that key preparation and integration objectives are met. Inquiry is one way of enabling the health professional guiding integration to work with the client in this way. Two methods (that contain significant overlap) of engaging in this process and integrating the psychedelic experience are somatic inquiry and mindful inquiry.
At this time, there is little evidence to support the use of somatic and mindful inquiry for psychedelic integration. This content reflects the general state of the field as best practices are in development for psychedelic integration.
SIBAM is a tool that is part of the somatic experiencing approach used to explore and process chronic stress and post-traumatic symptoms. It can also be applied to post-psychedelic integration processes.
Somatic Experiencing is a psychobiological model that utilizes the body as a place to direct attention (interoception, proprioception), and to work with implicit memory: a bottom up rather than a top-down approach. SIBAM is a framework that we have expanded to address psychedelic content.
The acronym SIBAM refers to:
Please ensure that you read through all items before proceeding by selecting each title.
Direct sensations perceived from the body (interoception, proprioception, internal sensations). For examples: tingling, tensions, warmth, spaciousness, clenching, and heaviness.
Sensation question examples:
These include images, colors, external senses (sight, smell, touch, taste). Somatic Experiencing also utilizes an external orientation to the environment as a tool to assist in client regulation.
Psychedelic visions can be a very common occurrence and can be worked with through the integration period. Dream images or spontaneous images that arise in the session can also be useful material to process. Such visions or images may have important meaning to the client and may be directly associated with their intentions. Here, visions or images are viewed as internal sight, versus in other models where they may be viewed as thoughts.
Image question examples:
Consider also the observable behaviours of the client both verbal and nonverbal, voluntary and autonomic processes, and conscious and out of awareness. For example: gestures, facial expressions, and other movements.
There could be a behaviour someone is hoping to change and the reason they are seeking therapeutic support. However, involuntary or small gestures may express themselves during the altered state experience, or in the integration session. By bringing this content into awareness it can also be processed. Behaviours can be utilized as a powerful way to ‘anchor’ meanings, clarified values, or other positive experiences the client wishes to carry forward.
Behaviour sample questions:
Emotions can also present as sensations (physical correlates). Since emotions are associated with the limbic system, they may have both the emotional (named) and sensorial quality.
Affect sample questions:
Meaning includes thoughts and language (associations, ideas, opinions, interpretations, conclusions). For example, verbal processing of information that arises directly out of the altered state of experience.
Meaning sample questions:
The intention of SIBAM is to invite people to become familiar with these five key domains through which they can process information and experiences. It should be noted that an experience may reveal itself through one or all the SIBAM avenues, and the role of the health professional is to encourage the connecting of these different ways of processing information simultaneously. For example, you could ask, “when you have that thought, what do you notice in the body,” thereby linking the meaning or cognition with the sensation or felt sense of the experience.
How can psychedelic medicines help increase a client’s ability to navigate SIBAM?
People may be more dominant in some areas and limited in others. Psychedelics may result in certain areas becoming more accessible than they otherwise would be. Therefore, it may be supportive to continue to work with clients using these newly accessible areas throughout the integration process. This can assist diverse ways of knowing and bring into awareness areas of perception that may have been restricted due to past experiences or trauma. It is common for people who participate in psychedelic experiences to feel a deeper sense of connection with their bodies and emotions.
For example, someone with anxiety and OCD could be primarily dominant in the domains of affect and behaviour and working with images or sensations could be supportive to increase their ways of moving through experience. We are trying to assist someone to potentially do something different while keeping them within their window of tolerance. Trauma reactions and other dysregulated states may be triggered, linked, blended, or coupled with a specific way of processing information. Therefore, we can focus our attention on other areas to assist the client to bring other components of the system to online. Culturally, cognition or meaning making is often prioritized. This is an alternative processing method that may disrupt unhelpful patterns or reactions, leading to their resolution, and integration into the client’s system.
Consider downloading this quick reference for SIBAM.
Mindful Inquiry is another way to work with clients during integration and shares commonalities with SIBAM. It also contains some differences in terms of how it categorizes experiences and how we bring attention to them. Mindfulness brings deliberate attention to experience, either through the investigation or the witnessing of its components. Treating all phenomena as sensations serves to decrease immersion in experience and assists clients to develop the skill of de-centering. In addition, one may work deliberately with the physical correlates of emotion to process them in a different manner than primarily using cognition. Lastly, the body (including breath) and its sensations become a place from which to witness the unfolding and changing nature of experience thereby enhancing meta-cognition.
Formal meditation or mindful attention utilizes a process of having an experience, reflecting upon it, abstracting about it, and then integrating it through active experimentation or application of what has been learned into everyday life. This is assisted through inquiry–either self-directed or facilitated by another. Attending in this way decreases the tendency to ruminate, providing the possibility of new ways of thinking about and working with challenging mind and mood states. It also allows for the opportunity to savour the positive.
In this model thoughts, emotions, body sensations and senses, and behaviours are viewed as the components of experience to be inquired into through noticing, tracking, abstractly conceptualizing about them, and then applying insights to daily life. This is distinct from narrating and analyzing experience.
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The body can be used as a source of information both in the past and present. Consider both internal and external sensations (touch, taste, sound, hearing, smell, thoughts).
Sample Inquiry Questions:
Emotions can be identified as single words (happy, sad, disgust, fear, joy, and others) and their physical correlates.
Sample Inquiry Questions/Statements
Thoughts appear as words, sentences, or images.
Sample Inquiry Questions/Statements:
Behaviours include actions, urges, and impulses to act.
Sample Inquiry Questions/Statements
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., and Rockman, P. (2021), Mindfulness-Based Stress Reduction: Protocol, Practice, and Teaching Skills. New Harbinger Publications Inc.