Psychedelic Integration

Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness by Marc Aixala is promising to be the guidebook for integrating psychedelic experiences. The book captures the work from the 1960s until the present on how to best integrate psychedelic experiences. The book is written for practitioners and the wider audience looking to learn about integration.

Publisher Summary

“Psychedelic Integration explores the young and still underdeveloped field of integration, tracing the history of psychedelic therapy trials in the sixties to the present moment, where integration may soon become common parlance in psychotherapy. This work describes how to maximize psychedelic integration, as well as the deep therapeutic work of moving through adverse reactions. Aixal undertakes the great challenge of transforming multifaceted psychedelic healing, which can often feel so ineffable, into an intelligible guide for the curious reader and practicing therapist alike. Braiding poetic metaphors with case studies and a multitude of spiritual traditions, this book situates the author’s humble and compassionate approach to therapy within a flourishing field. The work acknowledges that these models continue to evolve as they are written: the science and artistry of understanding psychedelic integration is and has always been a collective journey.“

Summary Review of Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness

Author: Alex Criddle is an independent researcher, writer, and editor. He has a Masters in Philosophy, where his thesis was on the nature of healing in psychedelic experiences. He’s worked as a researcher at a clinic doing ketamine-assisted psychotherapy and as a psychedelic integration guide. His writing, psychedelic philosophy course, and contact information can be found at https://alexcriddle.com

Introduction

Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness is written by Marc Aixàla. He is the head of clinical support for The International Center for Ethnobotanical Education, Research, and Service (ICEERS). This book weaves together the history of the discipline with Marc’s own experiences, training, and work running the ICEERS’ support services (they offer ten free integration therapy sessions for people who have difficulty after a psychedelic experience). He explained that for many of the cases he took early on he had no framework or resources to go off of and began to see patterns in the people he was helping. This book is sowed in his experience helping hundreds of clients with their difficult experiences.

This book will be helpful for people in professional roles, people who want to integrate their own experiences, and those interested in understanding how integration works after a psychedelic experience. He gives a solid historical grounding for the lens through which psychedelic therapy has been viewed in the past and present before launching into his own explorations and experiences with the topic. The book contains numerous case studies where he walks the reader through his approach to integrating certain difficult psychedelic experiences and gives extremely helpful metaphors for understanding the integration process.

Overall, this is an excellent book. Hopefully the first of many books on the topic of exploring integration and how it works meant for both professional and individual audiences.

Chapter 1 – The Origins and Evolution of Integration

  • There are two major approaches to using psychedelics for therapy: psycholytic therapy and psychedelic therapy. 
    • Psycholytic therapy involves the repeated use of low-medium doses to facilitate the emergence of unconscious material, allowing for a deepening of the therapeutic process.
    • Psychedelic therapy uses high doses in a low number of sessions to provide a peak experience to help reorganize the psyche.
    • Psycholytic therapy analyzes the content of the experiences much more than psychedelic therapy.
  • Aixàla then discusses the roles Betty Eisner and Ronald Sandison played in developing the understanding of integration, noting that the terminology was already being used in their work in the 60s and 70s.
  • Some authors see two different types of experiences that occur in psychedelic therapy: problem-solving experiences and integrative experiences. The former is when critical or problematic unconscious content is revealed, and the patient moves through these areas of the psyche and, if processed correctly, can be resolved positively. The latter is an experience where the patient accepts themselves as they are, and there’s a reduction in conflict.
  • Through the lens of historical psycholytic therapy, integration is two interrelated processes: relying on the therapeutic relationship to process and make sense of the content of the sessions and the unfolding of the integrative experience. This experience integrates the different layers of the psyche.
  • Aixàla then discusses the general history of psychedelic therapy, noting that in all the studies a positive outcome was closely correlated to the occurrence of a mystical experience.
  • One major figure in psychedelic therapy, Stan Grof, describes proper integration practices in the 80s, well after much of the work was done. He suggests that the integration process can take days or weeks and proposes some different activities to facilitate integration including: meditating, being in contact with nature, listening to music, long interviews with therapists, writing the experience, and artistic expression of the experience, among others.
  • After discussing the current work being done, he describes a newer methodology of integration being tested called Method Of Levels (MOL). It’s a type of interview based on the theory of perceptual control where specific questions help keep the individual in the present moment, aware of what is happening to them while they talk about their psychedelic experience. The goal is to give the individual a felt sense of what is happening to them while they process the content of their experience.
  • Other frameworks for integration include integration circles, Holotropic Breathwork, and Gestalt therapy.

Chapter 2 – About Integration

  • Aixàla stresses the importance of the broader process of the experience as interrelated and not distinct events: preparation, session, and integration.
  • He then discusses the current literature regarding the screening process for psychedelic therapy. Betty Eisner was probably correct in noting that the critical aspect of a successful experience/candidate was maturity.
  • In the context of psychedelic therapy and, he emphasizes, the psychonautical or neo-shamanic use of drugs, integration is understood as a sort of higher-level understanding of the experience and a proper application of the insights and lessons into our daily lives. However, he notes, the meaning of the expression is elusive and means different things in different contexts.
  • He says that while integration often does happen in psychotherapeutic and professional practices, integration and psychotherapy are not the same thing.  He notes that the objective of integration is limited and restricted to solving the problems that have led the person to seek the help of a professional, instead of continuing with the integration of the experience on their own, so then the mission of integrative psychotherapeutic intervention is for the client to regain a sense of control over what is happening to him and be able to continue on his way without the help of a therapist.
  • He then describes a series of metaphors to illuminate the concept of integration:
    1. the piece of the puzzle
      • A psychedelic experience is a puzzle piece that needs to be incorporated into the previously existing mental schema
    2. the non-existent ball and cube
      • A visual metaphor of 6 black spots shaped like pentagons that most people see a soccer ball in.
    3. the mathematical integral
      • Integration refers to an operation by which we try to find the origin of the function presented to us, however after a derivation, there is always a degree of uncertainty present in the “+C” portion of the integration.
    4. the everyday integral
      • An image of mathematical integration in everyday life.
    5. the tree with its branches and roots
      • The integration process is also reflected in the tree that grows tall towards the sky while its roots sink deep into the earth.
    6. chaos and order
      • An image of different spotlights of colours organized in two different ways, one showing order and the other chaos.
    7. planting seeds
      • Sprouting seeds reflect various aspects of integration, a psychedelic experience must be nurtured and cared for long-term.
    8. weathering the storm
      • Drogues are devices used in navigation to help maintain position. It provides greater stability by helping the boat face the incoming wind and waves. In rough sea conditions, in which navigation becomes impossible due to the crew’s exhaustion, seasickness, structural damage or accidents, the drogue allows the boat to remain stable and the crew to rest, overcome seasickness or fix the damage, maximizing safety and maintaining the position.
    9. decompression
      • Another situation that reflects different dimensions of integration includes the hyperbaric chamber used by a deep-sea diver, which regulates pressure and decompression before returning to land.
    10. developing a photo
      • Before digital cameras, people were used to the uncertainty of taking a photograph without seeing results immediately. The negative image contained all the information, but in a way that couldn’t be fully appreciated or understood for a time. The final result depended on the type of development chosen.
    11. weaving a web
      • Psychedelic experiences can be understood as distinct nodes, each containing a large amount of information yet disconnected from each other and our daily reality. Building bridges, creating connections and establishing patterns across these nodes allows us to weave a richer web of knowledge than the sum of its isolated nodes. Ultimately, integration, knowledge and transformation do not lie so much in individual experiences—not even in their symbolic content—but in those bridges and connections that weave them together with other significant experiences.
  • There is also ontological integration that is necessary. It refers to the content of metaphysical, spiritual, and philosophical conceptions about existence. At the ontological level, psychedelics can help us refine our understanding of our own intrapsychic processes, our character structure, and how our inner world affects our particular perception of the universe. They can also help sharpen our knowledge and experience of reality and its spiritual dimensions.
  • He lays out seven dimensions of integration: cognitive, emotional, physical, spiritual, behavioural, social, and temporal.
  • The cognitive dimension of integration is the one most often taken into account. In the West, it seems to us to understand the meaning of our visionary experiences and be able to interpret the symbols we encounter. This is not always the case in other cultures. Westerners tend to be fixated on producing a coherent narrative about our experiences. Working on the cognitive dimension of integration implies the ability to produce a narrative without gaps in experience. This can be difficult to achieve and becomes a significant concern. The human mind tends to fill in the gaps of what it does not know: it does not leave blank holes in an experience, often filling them in with anxiety and fear.
  • One of the most commonly experienced aspects of a non-ordinary state is increased accessibility to a broad spectrum of potentially intense emotional states. In the emotional sphere, good integration is not only the presence of positive emotions, instead, but it is also the presence of an open attitude while exploring the emotions that emerge in the process.
  • Aixàla mentions that it might be surprising that the spiritual aspects of integration may present serious integration challenges. However, on many occasions, the spiritual dimension is at the root of potential problems and possible solutions. We might find ourselves in contexts where there is limited understanding of the spiritual implications of a psychedelic experience. Suppose both therapist and patient subscribe to a materialistic, mechanistic worldview. In that case, the conceptual framework they are using will be limited in its capacity to understand many facets of the experience. However, the reverse situation is also possible: too much emphasis on the spiritual may lead to a “false” spiritual frame of understanding.
  • The behavioural dimension has thus been somewhat neglected in the humanistic and transpersonal fields, especially in some therapeutic approaches emphasising the supposedly spiritual aspects. For example, in Theravada Buddhism, the measure for evaluating a practitioner’s spiritual evolution is the development of increased compassion. The signs of a good integration—other than stability in the cognitive and emotional dimensions—must thus include successful, positive changes at a behavioural and ethical level.
  • In shamanic societies, the concept of integration is not necessary; the use of psychoactive plants that grant access to non-ordinary states or the spiritual dimensions of existence is already integrated into their worldview. There is nothing to integrate because that is already part of their way of life: it is already integrated. In a shamanic society, explaining the implications of attending an ayahuasca ceremony to anyone, including children, is unnecessary.
  • As Westerners, to process these experiences, we need liminal zones, intermediate spaces between the non-ordinary and the ordinary, both at the individual and the intrapsychic level. We also need spaces in the social and interpersonal spheres, such as consultation with a psychologist or attending an integration circle. We need practices that allow us to receive something profound from the experience, to translate from the spiritual or transcendental worlds back to our daily, rational lives.
  • The temporal dimension contains both the integration immediately after the experience and the long-term, downstream effects of the experience. One important factor is working with the individual to return to “normal” both physically and emotionally, allowing proper rest and recovery. The overall goal of integration psychotherapy is to provide a closing point that allows the person to focus on long-term integration.

Chapter 3 – Theoretical Foundations of the Clinical Intervention

  • A recent phenomenon is individuals who undergo psychedelic experiences under the care of a specific facilitator or shaman, but then look to external professionals for help integrating the experience. This can cause some difficulties because the professional was not present at the session and might not know or agree with the facilitator’s approach, paradigm, or worldview. These professionals might also be garnering clients from a wide variety of traditions and practices, and it’s impossible for an integration therapist to adopt or even know the worldview of all the different patients he treats.
  • Most schools discussed in the book propose an integration methodology based on some therapeutic method, but fundamentally the ontological foundation is similar: the continuous deepening of the analysis. And all of the schools are confused regarding the two integration categories: ontological and therapeutic.
  • Aixàla argues that considering the complexity of the psychedelic experience and the infinite range of possible experiences, our theoretical framework cannot be exclusively therapeutic.
  • He says we need a paradigm that can be applied to both the ontological and therapeutic dimensions of the experience that must have theoretical solidity and validity to explain the multiple phenomena while also providing us with practical applications to develop useful intervention methods in the different integration scenarios. We need a meta-paradigm.
  • He notes that constructivism isn’t just a recent phenomenon and has threads in many disciplines, cultures, and especially in psychedelic history. He will approach a particular constructivist perspective based on the Mental Research Institute of Palo Alto school.
  • These types of psychology and psychotherapy have been considered superficial by the schools of deep psychology—including the psychedelic and transpersonal gazes—because they focus on managing symptoms but fail to reveal the roots of the symptomatic manifestations. It is thus believed that they fail to catalyze profound changes in personality and the perception of the relationship with oneself, the world and reality.
  • Aixàla then reports that this book does not intend to provide an exhaustive exposition of the principles of constructivism applied to psychotherapy but rather to interpret them from the perspective of psychedelic integration.
  • He suggests that one of the main difficulties in creating a methodology is that the integration and the psychedelic experience happen in two different realities: the former in ordinary consciousness and the latter in a non-ordinary state. We are trying to integrate the infinite into the finite and two different types of logic into one.
  • There’s a problematic tension in psychedelic psychotherapy. During the experience, we encourage the person to experience any emotion fully and confront anything that comes. However, as soon as the experience is over, the therapist’s attitude changes and becomes frightened if the person continues to show intense emotions or has lingering emotional or somatic symptoms. Most therapists have few resources to deal with these things.
  • The integrative therapist should not fear the symptoms but learn to love them, to be fascinated by them
  • The chapter then turns to two mechanisms of change (Type 1 and Type 2) coined by Watzlawick, Weakland, and Fisch in 1976.
    1. A type 1 change is a change that happens within the same set or class and through the same operational logic. For example, when faced with an episode of insomnia or anxiety, an attempted solution could consist of trying to calm down, breathe deeply, relax, and promote sleep or decrease anxiety. If deep breathing doesn’t work, other solutions can be tried, such as counting sheep, self-hypnosis, playing relaxing music in the background, or structured breathwork techniques that time the inhales and exhales. Although these actions seem different, they are all part of the same class and follow the same logic: the class of “actions to relax and fall asleep.”
    2. The type 2 change implies a change of class, one that follows a different logic. Using the same example of anxiety or insomnia, a type 2 change could be getting up to read that book we have or taking advantage of our insomnia to tidy up the kitchen. The logic here is no longer inducing sleep or relaxation but staying awake and engaging in another activity.
  • He presents the example of Neo in The Matrix, who tried to find answers to solve his dissatisfaction with life. They are all unsuccessful and end up back where he started. These are type 1 changes. Once Morpheus appears and offers the red or blue pill. By choosing a type 2 change in the red pill, Neo acquires a higher level of logic and realizes the existence of the Matrix. 
  • Regarding the Palo Alto MRI, the psychedelic experience can induce a type 2 change. They give us the ability to think outside the established frameworks.

Chapter 4 – Maximizing Benefits

  • Aixàla suggests that one of the main setbacks in the therapeutic use of psychedelics is the impermanence of positive changes after a significant experience.
  • There are risks to skipping the integration step, in not taking full advantage of the experience, including ego inflation, spiritual bypass, and attachment and addiction to experiences.
  • A well-integrated ego death process often goes hand in hand with a sense of humility in the face of the greatness of the psyche, creation, the universe, or the mystery. Often, however, the processes of death and rebirth can remain half-finished. In such cases, the ego has experienced an opening towards the spiritual dimensions, and while greater degrees of freedom have been glimpsed, the process has not been completed.
  • Every seeker has to deal with ego inflation constantly. A single experience of ego death does not imply that one has transcended their ego.
  • The term “spiritual bypass” was coined in the 1980s by John Welwood, a Buddhist psychotherapist and practitioner. We might try to avoid suffering from living in the world through pseudo-spirituality. Many people may have had genuine spiritual experiences that led to a childish and unproductive form of spirituality due to poor integration. They can become attached to these pseudo-spiritual experiences and beliefs.
  • He highlights a distinction between the transcendent and immanent schools and practices. In the transcendent schools, we aspire to climb the mountain of enlightenment and reach powerful non-ordinary states of consciousness that allow us to open ourselves to realities beyond ordinary experience. The immanent schools have no particular interest in non-ordinary states of consciousness or the psychic phenomenology that occurs during practice. For Soto Zen Buddhism, all phenomena are nothing but makyo (illusion).
  • Psychedelic therapy can be understood as a transcendental school and psycholytic psychotherapy as an immanent school.

Chapter 5 – Cartography of Adverse Effects

  • While it is true that the use of psychedelic substances entails certain risks, and even when done in a controlled environment, we might occasionally face emergencies, these events are rare and can be resolved quite easily through pharmacological or therapeutic interventions.
  • Sidney Cohen describes the adverse symptomatology following LSD and classifies it into two main groups: 1) acute reactions and 2) prolonged reactions. One adverse effect that has penetrated the scientific literature and popular culture is the phenomenon called “flashback.” The authors who best described the flashback were Fred Shick and David Smith, who differentiated three distinct categories within the same phenomenon:
    1. perceptual flashbacks (transient and non-problematic visual changes that do not require much therapeutic support)
    2. somatic flashbacks (experiences of physical sensations similar to those of a previous psychedelic journey)
    3. emotional flashbacks (intensely re-experiencing unpleasant emotions such as anxiety, fear or sadness)
  • The first category of flashbacks received a lot of media attention and gave rise to the diagnosis of PHPD (Post Hallucinogen Perceptual Disorder, also coined HPPD).
  • In Aixàla’s work, he’s reached similar conclusions as Cohen, Shick, and Smith’s. In his work, he’s seen seven different categories of integration problems: Lack of preparation or context, unresolved difficult experience, the emergence of a previously unknown traumatic memory, abuse by the facilitator/shaman and interpersonal difficulties, traumatic dissociative experiences, seeking out repeated experiences without proper integration, and previously existing mental disorder. He describes examples of each of these and two cases that constitute spiritual emergencies arising from a session and how to work through them.

Chapter 6 – Intervention in Integration Psychotherapy

  • Aixàla begins by discussing the different models for treatment duration and how many sessions are typical for psychedelic therapy.
  • One of the most important traits a therapist can develop is radical respect for the client, the client’s experience, and their worldview. He also mentions that relying on the client’s ability to solve their difficulties is crucial by “honouring their inner wisdom”.
  • Another facet of the interventions should include a clear definition of the problem and the goals to attain and, in the process, reroute the situation from dealing with adverse effects to maximizing the benefit of the same experience.
  • Aixàla then applies his intervention techniques presented to a series of clinical examples going into detail about the interventions he takes, the time frame, and the goals for sessions along the timeline for each of the seven integration problem categories mentioned in the prior chapter.