Integration in Psychedelic-Assisted Treatments: Recurring Themes in Current Providers’ Definitions, Challenges, and Concerns

The present study (n=30) interviewed integration therapists to better define integration and any challenges/concerns that they associated with the practice. Themes such as expressing concern about nonresponsive clients, defining integration as a bridge between the psychedelic experience and daily life, and apprehensions about the commercialization of psychedelic psychotherapy, were identified. Interviewees also discussed issues related to client resistance, unrealistic expectations of psychedelic psychotherapy, problems associated with power differentials, and more.

Abstract

“Integration therapy, an integral part of psychedelic-assisted treatment, usually includes sessions devoted to making meaning of relevant psychedelic experiences after subjective effects have subsided. As the psychedelic renaissance continues, offers for this integration therapy have proliferated. In the present project, semi-structured interviews with 30 integration therapists focused on definitions of integration as well as challenges and concerns that they associated with the practice. A mixed-methods approach revealed 19 themes that coders identified reliably. Prevalent themes included expressing concern about nonresponsive clients, defining integration as a bridge between the psychedelic experience and daily life, and apprehensions about the commercialization of psychedelic psychotherapy. Interviewees viewed integration as a process that begins prior to the administration of substances, never ends, makes sense of the psychoactive experience, creates behavioural change, is personalized, and makes the individual whole. Most participants also discussed issues related to client resistance, unrealistic expectations of psychedelic psychotherapy, problems associated with power differentials, the importance of an integration therapist’s connection to other service providers, and the need for self-care. These data might help the standardization of integration therapy, inform lay impressions of the process, and help generate hypotheses for continued research on this aspect of psychedelic-assisted treatment. These data also suggest that psychedelic integration practitioners would appreciate regular support from a community of like-minded colleagues.”

Authors: Mitch Earleywine, Fiona Low, Carmen Lau & Joesph De Leo

Summary

Abstract

Integration therapy is an integral part of psychedelic-assisted treatment. It involves making sense of the psychoactive experience after subjective effects have subsided, and is a bridge between the psychedelic experience and daily life.

Clinical trials reveal that psychedelic-assisted treatments have considerable potential. These treatments usually involve three steps, dubbed preparation, guided administration, and integration, and involve a professional who explains the process, helps set reasonable expectations, and offers reassurance during challenging moments associated with acute effects.

Early research rested on psychodynamic theories, and subsequent research combined the psychedelic experience with empirically validated psychotherapies. Some research groups point out that the same mechanisms known to underlie empirically supported treatments might also be responsible for the therapeutic effects of psychedelics.

Authors vary in their emphasis on the need for support throughout the process of psychedelic therapy. Some clinicians emphasize the importance of integration sessions, while others focus on the client’s needs, personal perspective, and commitment to spirituality.

Current work does not reveal sufficient details to generate extensive, testable hypotheses about the process of psychedelic integration, so we interviewed people who provide the service to see how they define it.

Participants

Participants were 30 interviewees who lived in the United States, Canada, Mexico, Costa Rica, or Trinidad and Tobago. Eleven were female, two were nonbinary, two were two-spirit or fluid, and 15 were male. The modal education group included those with a master’s degree or higher in clinical or counseling psychology, a high school diploma or equivalent, a Bachelor’s degree in psychology, a Doctorate in clinical or counseling psychology, and one who was currently working on a doctorate.

We placed advertisements on social media, emailed members of integration lists and social networks, and contacted personal networks willing to send the request to relevant colleagues. 31 participants agreed to participate for at least an hour in exchange for a US$50 gift certificate.

Procedures

All procedures were approved by a North American Institutional Review Board, and interviews were conducted via zoom or telephone. The interviews were audio-recoded and transcribed verbatim.

Qualitative Coding

The interviewer and two other authors identified recurring themes in the interviews, and the two authors who had not conducted the interviews took input from the interviewer, read all transcripts, and generated lists of themes independently. They met to discuss emerging patterns among themes, and refined definitions.

Two coders without personal contact with the interviewees coded all the transcripts based on the provided definitions. Nineteen of the 21 proposed codes had acceptable values of agreement, and two codes were dropped.

Quantitative Analyses

We used nonparametric analyses to examine the presence and absence of qualitative themes in the interviewees and how they varied with demographic variables, orientation, and training.

Overview

Coding of the interviews suggested that integration is a bridge from the psychedelic experience to everyday life. Integration therapists mentioned a lack of client response to the treatment, client resistance to the treatment, and self-care needs of the integration therapists.

Interviewee Orientations or Techniques

Participants reported using an array of techniques and approaches, including Family Systems, Mindfulness, Breathwork, Transpersonal, Jungian, Grofian, Existentialism, Narrative, Cognitive Behavioral, Motivational Interviewing, Hakomi, Eastern Traditions other than Mindfulness, Somatics, and Embodiment.

Coding Themes: Defining Integration

Seven reliably coded definitions of integration were found, with the most common definition focusing on integration as a bridge between the psychedelic experience and daily life. No other codes were associated at statistically significant levels.

Coding Themes: Challenges

Interviewees explained what challenges they faced while performing integration therapy. The most common challenge concerned client nonresponse, the next most common challenge concerned client resistance, and the third most common challenge involved therapist self-care.

Coding Themes: Concerns

Interviewees expressed concerns about the commercialization of integration therapy, misunderstandings of psychedelics as a panacea, cultural issues in the way that psychedelic therapy is currently conducted, and power differentials in the relationship between clients and therapists.

Additional Themes

Three additional themes appeared in interviewee responses, including concerns about personal use of psychedelics for the therapists, the importance of a practitioner community familiar with psychedelics, and the need to take a client-centered, nondirective approach for integration therapy.

Discussion

Analyses of the interview data revealed multiple recurring themes, including definitions, challenges, and concerns. These themes were independent of demographic characteristics or certification status of the therapists, and can inform subsequent research on integration.

Integration Defined

Interviews with 30 integration therapists suggested a multifaceted definition of integration that includes making sense of the psychedelic experience in everyday life.

Domains for Challenges and Concerns About Integration

Interviewees discussed challenges and concerns related to psychedelic integration.

Integration therapists mention issues relating directly to clients, such as nonresponse and client resistance. They suggest that future research should focus on identifying predictors of treatment outcomes and on helping practitioners to maximize their impact via self-care and relevant social support.

Limitations and Future Directions

The current data provide novel empirical information about integration, but further research is needed to determine the effectiveness of the psychedelic treatment process.

Generalizable, stratified sampling could reveal covariation with approaches to integration, and a focus on speakers of languages other than English could provide a different view of the practice of integration.

The identified view of integration therapy parallels motivational interviewing, a brief intervention based on Rogerian Therapy that utilizes client-centered social interactions to improve health behaviors. Many integration therapists might behave in ways that are consistent with the motivational interviewing approach.

Motivational interviewing and psychedelic integration might work in similar ways, and coding for variables like these in recorded integration sessions could provide valuable insights into how to maximize the impact of integration therapy.

Despite limitations, the 19 themes identified in the present study appeared frequently enough to recommend serious consideration. Further research could focus on identifying predictors of efficacy, and on identifying specific definitions of integration, associated techniques or approaches, and awareness of challenges and concerns.