Psychedelics

Discussion of a client’s previous psychedelic use in a therapeutic context is legal and is

essential for psychedelic integration psychotherapy (PIP), however most psychedelic

medicines remain federally illegal and Wholeness Center will neither provide nor endorse the

use of illegal substances. Rather, we believe in a model of harm reduction which seeks to

reduce risks and maximize benefits, as opposed to embracing moral or disease models of

substance use which have proven to be ineffective ( Neuroethics. 2017; 10(1): 129–139.)

We acknowledge that people will choose to take risks which may not be legal or medically

advised for a variety of reasons. Therefore, we have designed PIP to allow for a non-

judgmental, non-stigmatizing space where clients may feel safe and free to speak openly

about past experiences with the knowledge that they will remain confidential.

In keeping with the harm reduction model, compassion and respect for personal autonomy

remain at the forefront while therapists aid clients in processing past experiences, developing

treatment goals, and fostering resilience for future challenges. Therapists and medical

professionals at Wholeness Center have completed and led professional trainings in this

burgeoning field, as well as draw from personal experiences working with psychedelics and

non-ordinary states of consciousness. Through this combination of professional training and

personal introspection our clinicians are prepared to hold space and facilitate the

transformation of past psychedelic experiences into lasting insights and personal

understandings of oneself.

Although it is possible to experience profound healing through unstructured or recreational use

of psychedelic medicines, these substances are not without risks, and these risks may be

amplified for those who are already experiencing mental health challenges. Psychedelic

medicines are not a “magic bullet” which guarantee healing. Rather, clinical trials conducted

around the use of ketamine, MDMA, and psilocybin have found that these medicines greatly

enhance the efficacy of psychotherapy, and psychotherapy remains an integral portion in

facilitating a return to greater levels of well-being and wholeness. (Pharmacopsychiatry 2021;

54(04): 167-175)

Why integration with a professional is so important before and after an experience?

Through research and the clinical experience of providers at Wholeness Center, it has become

clear that it is important to meet for at least one preparatory session prior to a psychedelic-

assisted psychotherapy session. This gives the client and therapist an opportunity to establish

rapport and discuss expectations and support systems which the client may have in place, and

to assist them in developing support systems if they are not present. This is also a critical

time to have a discussion around goals and intentions. Treatment goals focus on what the

client wishes to achieve upon completion of their sessions (i.e. a reduction in depression,

working through trauma, feeling less stuck, etc..), whereas intentions are more broad and are

meant to bring a spirit of inquisitiveness and curiosity to an area in which a client may feel

stuck.

Psychedelic-assisted psychotherapeutic models often align with an inner focused, non-

directive model through which clients obtain insights from within. The concept of an inner-

healing intelligence is often emphasized here, which refers to the knowledge and power within

oneself to move towards wholeness and wellbeing. Bringing an intention provides an

opportunity to call forth a hope for healing or insights around a particular topic, and an

opportunity to then release it and be open to whatever comes forward in the session. Often,

the intention is met in the session and provides future therapeutic directions. The therapist

remains present in the room to hold space for the client and assist as needed.

Progress towards treatment goals tends to accrue rapidly in psychedelic-assisted

psychotherapeutic models, but there is a risk of regression if insights are not nurtured and

supported via ongoing introspection and integration. Through this process of integration, the

therapist and client work together to integrate lessons and insights from the experience back

into the client’s life. This work begins as soon as the psychedelic medicine is beginning to

wane and the client begins re-orienting to the room and engaging with the therapist once again

and continues in separately scheduled therapeutic integration sessions.

Integration must also factor in what happens before and after the session however, and any

behavioral changes which may be appropriate to bring into one’s life. Journaling walks in

nature, creative endeavors, time spent listening to music or speaking with friends, and other

personally meaningful methods lay the groundwork for a client and therapist to transform their

insights into lasting changes and behavior in the psychotherapy integration sessions in

between their experiential sessions. During this time the therapist will check in around

movement towards treatment goals and provide a warm, compassionate presence while

assisting in processing insights from the previous sessions, as well as potential challenges or

hurdles going forward. Intentions for future sessions are also often explored at this time. How

to prepare the space, when to intervene, and when to encourage stillness and inner

exploration remain important considerations for the therapist to hold.

Creating the optimal environment for deep healing

Even in the early days of western approaches to psychedelic therapy as Albert Hoffman and

others began attempting to work with LSD and other medicines, the crucial importance of set

and setting was identified. The client’s set is essentially their current mental state, and the

setting can be broadly described as the physical environment of the experience, which has a

significant impact throughout the experience. For this reason, psychedelic therapeutic

modalities often try to create a therapeutic setting which may appear more similar to a living

room at first glance than a clinical office.

Gentle scents and calm, ambient music may be present. This music may become more active

as the session unfolds depending on the client’s intentions. Above all, the client should feel

safe in the room, such that they are able to soften into their experience and allow their

conditioned thinking mind to take the back seat, as they move into an experiential and

observing state with the introduction of the psychedelic medicine.

There are some common pitfalls to avoid here. It is worth considering that no matter how well-

resourced and prepared a client is, if they find themselves in a deeply vulnerable psychedelic-

induced state in a noisy office with anxious or agitated people coming and going, they likely

are not going to have a profoundly positive experience. Likewise, no matter how perfect a

playlist and how calm and tranquil a “living room-esque” office a therapist has crafted, if a

client has been chronically sleep-deprived, recently experienced a traumatic event, or if there

are background or cultural contexts that the therapist is unaware of, these elements are also

going to be present in the session and may become prominent in it.

Common recommendations for avoiding this are to meet with the therapist for preparatory and

integration sessions to ensure the client is in a good space to begin or continue the treatment.

It is also often recommended that the client not rush right from a busy day into the therapeutic

office, but rather spend some time going for a walk and allowing their nervous system to settle

and prepare. If a client has recently endured loss or a significant personal set back, it may be

wise to reach out and reschedule the appointment or meet for a psychotherapy session

instead.