In last week’s blog, Ed Prideaux told us everything we know (and don’t) about Hallucinogen Persisting Perception Disorder (HPPD), visual snow syndrome, and flashbacks. In part 2, he addresses ways to deal with the distress of having HPPD and ways to reduce the risk of developing it in the first place.

The real “problem” with HPPD is distress: anxiety, depression, isolation, panic, and the unhelpful coping mechanisms people can develop to overcome these (alcoholism and drug dependency are sadly common among HPPD patients). Remember, this distress is what technically defines HPPD.

Many people live with significant visual changes and do not find them distressing – rather, they may be sources of enjoyment, “free trips,” artistic inspiration, or purposefully leaned into as part of spiritual or occult practice. The world looking different doesn’t necessarily mean you have a problem. 

If you’re currently experiencing HPPD, though, overcoming the distress should probably be your first priority. Speaking crudely, once the distress is overcome, the visuals can more or less “take care of themselves.” With less distress, there is less fixation. With less fixation, there is less noticing. With less noticing, the visuals are less noticeable. They may rapidly normalize, filter in the background, and can disappear unexpectedly with time.

How Can We Address This Distress – and Bring the Visuals Down?

Medication and clinical help:
Many in the HPPD community have found relief in the use (especially in the short-term) of medications including Lamotrigine and Klonopin. They can bring visuals and anxiety way down, though some report their symptoms getting worse. They can always bring side effects, too, so some caution is advised.

Do not be surprised, either, if clinicians have not heard of HPPD. It is little-known and poorly-understood. It may be useful to refer your clinician to the Information Guide included on the Perception Restoration Foundation’s website.

Healthy lifestyle changes:
Many HPPD patients report the decline and resolution of their symptoms – or otherwise acceptance and returning to “normal” life after avoiding further drug-taking, exercising regularly, cutting out processed foods, or trying specific elimination diets.

Noting Triggers: 
Pay attention to your triggers and act accordingly. Visuals and other HPPD symptoms can surface in response to:

• Fatigue
• Stimulation, including caffeine 
• Anxiety and stress
• The nature of the environment: visuals are more apparent in the dark, on blank surfaces, in enclosed rooms, and in environments where people had their original psychedelic experiences
• Specific foods 
• Fixation and attention, including staring at blank surfaces and an anxious tendency to look out for visuals 
• Intoxication with other drugs, especially cannabis 

You should also pay special attention to how your condition manifests beyond visuals, in particular, if you are experiencing Depersonalization/Derealization Disorder. More than visuals, it’s often the case that people’s distress comes from DP/DR, and a rich body of literature and therapeutic approaches have been explored for this condition. 

Community: You can seek community from others, such as groups on Facebook, or the forums at HPPDOnline.com, r/HPPD, or r/visualsnow. However, tread cautiously around spending too much time on these forums. They can be extremely negative, and cause people to spiral and fixate on their perceptual changes.

Mindfulness meditation: The stress reduction and relaxation effects of meditation are well-established; many report breaking the cycle of visual fixation through learning to hone their attention.

Cognitive techniques: Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) may be useful for accepting and reframing perceptual changes. Challenging the internal beliefs triggered by HPPD could reduce both distress and the visuals – in particular, the beliefs that patients are “brain damaged,” “weird,” “isolated,” or a “casualty.”

Psychedelic integration: Introspection, journaling, and (if you can find and afford it) specialist, psychedelic-informed counseling can be helpful. In particular, you may benefit from exploring the particular details and events of what may have caused HPPD to originally materialize.

Somatic approaches: Certain somatic/bodily therapies have proven helpful for people with Visual Snow Syndrome. This includes the use of acupuncture, muscle relaxation techniques, neck massage, and specific dietary interventions.

Reframing: It may be helpful to learn that many people are not troubled by their perceptual changes. Again, they can be just a “thing” – how one sees now – that’s different, and not necessarily bad. Other people actively enjoy their perceptual changes or view them in a spiritual way, such as glimpsing auras, having broadened the possibility of the mind, or in seeing the intrinsic shakiness of ordinary experience.

Without a deep, embodied grounding for your reframing, though, it can be hazardous. Make sure the frame is not just “in your head,” but truly held across your entire mind and body in a felt way. Don’t gaslight yourself into enjoying your perceptual changes if they are actually disturbing you.

How Can One Reduce the Risk of Developing HPPD When Taking Psychedelics?

There is reason to suspect that the immediate period after a trip – say, one-to-five days – is important. This is because the brain is still neuroplastic and affected by psychedelics for up to a week (or longer) after the trip. And HPPD may be understood as a problem of “resetting” one’s brain back into its ordinary perceptual categories after the shock of a psychedelic experience.

If you want to avoid HPPD, what matters is ensuring that your perception re-transitions to its prior sober state safely. In this one-to-five day period, it may be advised, then, to:

1. Sleep well.
   
2. Avoid cannabis and further drug-taking. Some people report that their HPPD was “kicked in” by a subsequent drug experience.
   
3. Process the psychedelic experience through dedicated integration practices, such as journaling, contemplation, meditation, and inquiry. Speaking very crudely – and because HPPD may well be a “network disorder” involving cross-connected mixtures of perception, emotion and cognition – it may be that failing to integrate the experience may cause the energy to remain and be reactivated, including in cognition and possibly in perception (especially if the right triggers are also hit).
   
4. Keep stress and anxiety to a minimum.
   
5. Re-embodiment, or reconnecting to body sensations. Practices may be recommended, including through mindfulness meditation. This may help to reduce the risk of dissociative disorders like Depersonalization/Derealization as well.
   
6. Reduce screen use. Focusing on screens may cause a disembodying effect, as well as holding back the psychological energies activated by the psychedelic experience.
   
7. Avoid triggering environments, such as places that are enclosed or rich in blank surfaces, and try not to self-induce visuals through staring and fixation. If someone wants to be extra careful, they may wish to avoid the place where they had their psychedelic experience. “Training” the brain in hallucinatory ways of seeing while it’s neuroplastic may cause lingering changes once neuroplasticity is reduced and stable categories are reaffirmed.

Important Questions to Ask Before Having an Experience

Have you optimized your set and setting?
HPPD seems to be more likely after bad trips or challenging experiences – the likelihood of which strongly depends on how people organize their set and setting. In particular, stress and trauma going into a psychedelic experience may be a trigger for HPPD experiences, even at low dose (and microdose) levels.

Have you experienced some unusual visuals before?
HPPD patients may have had a higher-than-normal experience of certain visual oddities, which are rare parts of normal perception. In particular, phenomena like visual snow, halos, after-images, floaters, and colors in the dark may suggest an underlying tendency in perception that could be triggered by a psychedelic drug to be more intense.

Have you tested your drug? If so, what drug are you taking?
HPPD may be more likely with Novel Psychoactive Substances (NPSs) and Research Chemicals (RCs) with more unpredictable, less-researched, and possibly neurotoxic effects. Adulterants in street drugs may also have neurotoxic and other risky properties.

It seems that long-acting psychedelics like LSD are more likely to cause HPPD. While LSD may have certain advantages over other psychedelics subjective to each user, someone very conscious of developing HPPD (at least compared to other risks) may wish to avoid LSD in favor of a shorter-acting psychedelic.

How often are you tripping?
Taking lots of psychedelics frequently is likely to be correlated with a higher risk of developing HPPD. This can be explained in a number of ways:

1. A higher likelihood of having a bad trip
2. Activating a latent genetic susceptibility 
3. More likely to over-excite relevant perceptual circuits
4. More “re-training” of perception in hallucinatory ways of seeing
5. Less time in which to integrate properly one’s experiences, and a possibility of a “cascade” of neuroplasticity from taking psychedelics while still in a neuroplastic state
   
   Do you have experience of Obsessive Compulsive Disorder (OCD), Autism Spectrum Disorder (ASD), Complex PTSD, Generalized Anxiety Disorder (GAD), or Attention Deficit (Hyperactivity) Disorder (ADD/ADHD)?
   While there has not been research on the relationship of HPPD to these conditions, reviews of online forums directly and indirectly suggest a relationship. People with Visual Snow Syndrome seem to experience these conditions more than average based on rough overviews, and people with these conditions may independently report certain visual changes similar to HPPD. If there is a relationship between HPPD and these conditions, the connection may occur through tendencies towards disembodiment, hypersensitivity, overstimulation, and dissociation, all of which may have visual components – and may be amplified by psychedelic experience.  

For more, this article’s tips, advice, analysis (and more) is also featured in a more in-depth HPPD Information Guide, which can be freely downloaded from the Perception Restoration Foundation’s website, where a more direct guide for those struggling with HPPD is also hosted. Owing to the tentative nature of our HPPD knowledge base, the PRF invites any and all comments and criticisms for the Guide at info@perception.foundation, and any worthwhile amendments will be quickly published.

Internal Family Systems therapy, or IFS, is an effective complement to psychedelic therapy and integration. But how does this therapeutic approach – best known for working with the many pieces of the psyche that comprise one’s personality, or “parts,” – work in conjunction with psychedelic medicines?

My own experiences with this modality enabled me to better understand how it works.

Navigating inner space is always a surprisingly visual journey for me. In one particular session, my eyes had been closed for a while. And this time, in a guided Internal Family Systems (IFS) therapy session, the powerful visual component was exactly the same.

There are many paths from which one can enter the inner world, known as “trailheads” in this detailed method of psychotherapy. Just taking a few breaths within this dark, introspective place, I could feel something churning like magma in my stomach. I saw and felt hot, crackling flames of anger percolating within my abdomen; painful memories of betrayal filtered through my consciousness.

Using this bodily trailhead as an entry point and working through the “parts” that hallmark the IFS approach, my therapist began to gently ask about it, as if the anger was a sentient presence.

“What would your anger do if it didn’t have to keep doing this job?” I heard from what now seemed like a far-off place.

“I don’t know,” I mumbled. “I like the anger. I know it’s here to protect me. We get along.”

It felt deeply familiar, like a well-worn sweatshirt that I couldn’t bring myself to let go of. It was safe. Or rather, it kept me safe. In the language of IFS, I had contacted a protective part of my psyche, which in this case, was a flaming cauldron of anger.

“Good. Let the anger know that you appreciate it. Really let it feel that… what does the anger have to say to you now?”

“That sometimes we lose people,” I sighed. “And that that’s OK.” These simple words gave way to a massive sense of release.

I felt the turbulent energy inside me suddenly transform into something which encompassed my entire awareness. The fiery magma of anger which coursed through my body a minute ago shifted into something that I can only describe as an emotionally expansive, all-inclusive moment of peace.

This space was familiar. I had felt it before, this wordless balance between bliss and sorrow which the thinking mind, or “ego”, seems to dissolve in.

Now, instead of feeling the flames inside me, I was inside the flame itself. I felt my entire body relax. My mind, a psychic battleground only moments before, was quiet. 

I exhaled into a stillness which resonated throughout my cells. The immensity of all of life’s crushing beauty somatically flooded through my nervous system and inner vision. I felt my heart beat and my lungs expand as forgiveness flowed through my entire body. My mind relinquished control, letting the story behind this painful life chapter melt into the purifying, boundless flame I suddenly found myself engrossed in. I was deeply immersed in what IFS therapists call the energy of “the Self.”

The distant voice advised me to stay there as long as I could. And so I did, until time began to loosen its grip upon my consciousness.

When I finally opened my eyes, I was still high.

This experience could easily describe some of the most profound moments I’ve had with psychedelics. I am confident it would land somewhere on the Pahnke-Richards Mystical Experience Questionnaire, the same scale used in Roland Griffiths landmark 2006 Johns Hopkins study on psilocybin and mystical experiences. Yet, this powerful inner experience was mediated through the internet, between myself and another person, without any substances whatsoever.

As powerful as any psychedelic moment of healing, this visionary journey was facilitated by a therapist in my Internal Family Systems (IFS) therapy training program. After being guided through this modality, my suspicions around its potential for use in psychedelic therapy and integration were confirmed beyond a doubt.

What Is Internal Family Systems (IFS) Therapy?

Developed by Dr. Richard Schwartz in the late 1980’s, Internal Family Systems is a psychotherapy modality rapidly growing in popularity. As an outgrowth of his work studying family systems therapy and working with patients struggling with severe eating disorders, Schwartz noticed that his clients spoke about their inner conflict in terms of “parts” of themselves guiding their troubling behaviors and inner conflicts.

In what is ironically a radical act in many areas of the psychological establishment, Schwartz actually took his clients at their word.

Integrating his knowledge of family systems, as well as the work of Carl Jung and other psychotherapeutic pioneers, Schwartz created the IFS model which embraces the notion that our personalities are actually composed of a symphony of different parts, as well as a core, boundless source of energy that both Jung and Schwartz deemed “the Self.”

“There are times where you just can’t convince these protective parts to let us get to an exile and heal it. And a psychedelic session can expedite that pretty easily, it seems,” Schwartz told Psychedelics Today.

Michael and Annie Mithoefer, pioneers of the MDMA-assisted psychotherapy protocol currently used by MAPS, are trained IFS therapists and integrated this method into their work.

When asked about working with IFS and MDMA, Mithoefer said, “I have learned how well the spontaneous observations and experiences of our participants map onto IFS, including both parts and the Self… in my experience, people are hungry for this perspective. (Richard Schwartz) didn’t make it up – IFS taps into real phenomena.”

Schwartz says his experiences with psychedelics and the insights he gathered through substance work helped open his awareness to the “multiplicity of mind,” a core principle of IFS.

In the past, the field of psychology viewed subpersonalities with great skepticism, giving way to infamous diagnoses such as dissociative identity disorder (DID), formerly called multiple personality disorder (MPD). Yet IFS, a non-pathologizing form of psychotherapy, looks at the many subpersonalities, or parts, as natural facets of the psyche–aspects of ourselves which yearn to be known, understood, and healed.

As a depth psychotherapist, I was trained to suss out the unconscious and possibly archetypal aspects of a given dynamic or situation with my clients. Image and metaphor have long been the bread and butter of depth psychology, with myths and fairytales frequently providing the backdrop for some of this tradition’s most memorable texts. In other words, both depth psychology and IFS take to heart the notion that image and psyche are one and the same.

After slowly developing my own therapeutic style, which is influenced not only by human teachers, but psychedelic plant teachers as well, IFS felt like an immensely practical tool with which to weave this odd tapestry of animism, image, and archetypes.

After all, what is an archetype if not psychic energy crystallized into an image?

What are “Parts” in IFS?

For millennia, psychedelic medicines have been used by humans to invoke visions, as well as bring one into dialog with some larger presence: the Great Spirit, the spirits of teacher plants, animals, elements, or the ancestors. Especially with ayahuasca, DMT, and other tryptamine-containing substances, people report encountering beings or entities who often communicate detailed information that can be recalled after the effect itself has worn off.

Whether these entities are mere reflections, or personifications of psychic parts, is a valid, but different, discussion. The point is that when one goes deep enough into the mind, research and anecdotal evidence proves that it is not unusual to encounter presences that seem entirely other than one’s own self.

Instead of entities, beings, or spirits, IFS employs the language of parts to describe the psychic presences which collectively constitute one’s personality.

As a psychedelic integration therapist, IFS provided me with a systematized toolkit for working with people trying to make sense of the paradigm-bending moments that can often occur during a psychedelic journey.

For example: take the voice that suddenly tells you to quit your job; the sinking feeling in your stomach when you think about a memory from childhood; feelings of unworthiness that you’re doing it all wrong; or that suddenly you’re not safe, despite all evidence to the contrary. From the IFS perspective, these are most likely parts expressing themselves and asking for your attention. From a shamanic perspective, these messages might be coming from the spirit of the plant you just ingested, from the ancestors, or from something else entirely.

For psychedelic explorers who prefer not to think in terms of spirits or entities, IFS can provide a useful method of conceptualizing and categorizing potentially confusing aspects of psychedelic experiences that might not fit within their worldview.

Defining “Self” in Internal Family Systems

Both IFS and psychedelics work by reconnecting one to an internal source of transpersonal energy, which Schwartz, taking a page from Carl Jung, calls “the Self.”

IFS has the potential to lead one into profoundly visionary and emotionally cathartic experiences. For me, IFS has been comparable to some of the most healing moments that I’ve experienced with psychedelic medicines.

IFS can provide both facilitators and participants a language by which to conceptualize and map an experience that would otherwise be, by its very nature, ineffable.

In describing the energy of the Self, Schwartz developed what he calls the “eight C’s”: 

1. Compassion 
2. Curiosity 
3. Calm 
4. Clarity 
5. Courage 
6. Connectedness 
7. Confidence 
8. Creativity

In IFS, it is the energy of the Self, not the therapist, that truly heals.

The good news here is that everyone, regardless of past trauma or experiences, has within them the boundless energy of Self. Thus, IFS believes that everyone has the capacity to heal.

The notion of the Self firmly locates IFS therapy in the terrain of existential-humanistic, transpersonal, and depth psychology, all of which form the foundations of emerging and long-standing modalities of psychedelic psychotherapy (for examples, see Grof, 1975, Stolaroff, 1997, and Leary, Metzner & Alpert, 2007). 

One could say that within the psychological establishment, the idea of the Self is as radical a notion as LSD being used to heal. In many mental health agencies or governmental health services, both concepts would likely be given a sideways glance at best, mockery or early termination at worst.

In my own psychedelic experiences, I can recall moments of feeling immersed in many of the eight C’s. Formal research has yet to be conducted connecting the Jungian and IFS concept of the Self within psychedelic experiences and its potential for healing, though the work of Stanislav Grof, as well as Griffith’s research mentioned above, comes close.

Perhaps the expansive, all-encompassing energy of the Self is what the famous Mazatec curandera, Maria Sabina was referring to when she said, “Heal yourself, with beautiful love, and always remember, you are the medicine.”

How Psychedelic Integration Could Employ IFS

After a psychedelic experience, my clients often share what can seem like a deluge of information, imagery, and questions. In addition to archetypal imagery, transpersonal, and shamanic perspectives, IFS provides me a detailed map for understanding and deeping into the integration process with clients. Often, there are recognizable themes or patterns that can emerge during a psychedelic experience – for good or ill.

Here are some core concepts in IFS therapy that I have found useful while facilitating integration work: “Unburdening,” “Polarization,” and “Blending.”

“Unburdening” in IFS

If one could distill IFS therapy down to a single sentence, it could be that it consists of helping certain parts of ourselves let go of outdated or inherited ways of being that cause us to suffer.

IFS calls this process “unburdening,” as it understands that certain parts take on “burdens” early in life which, as we grow, might become less and less helpful or healthy.

This unburdening is achieved by establishing a connection to the Self, so that the part can realize it doesn’t have to do it all by itself, that it’s not alone, and that its past experiences don’t dictate the future. Usually, these moments are profoundly cathartic and emotional. It can also take an immense amount of work to get there, which is why psychedelics can potentially play a helpful role in this therapeutic process.

From an IFS perspective, unburdening is often what happens in a positive psychedelic experience, and can be some of the most memorable moments of the journey. For example, metaphorically giving your anger to the fire; letting your grief float away into the ocean; or planting your sadness into earth. Such images are common in both IFS therapy sessions and psychedelic journeys.

Through the lens of IFS, our stories about who we are or how the world is might be a burden carried by a part. For instance, seeing oneself as a savior, victim, martyr, or outcast is a story that might be severely limiting one’s idea of who they really are and their self worth. Tendencies towards workaholism or scarcity fears, chronic shame, feelings of not being enough and needing to prove oneself, are all burdens that certain parts might carry for decades. Many burdens were placed upon us during childhood by family members, and in that sense are not true reflections of who we really are.

On an even deeper level, some burdens are inherited through our blood lineage and ancestry, or experienced through what author and psychotherapist Resmaa Menakem calls HIPP (historical, intergenerational, persistent institutional, and personal) trauma. These heavy burdens may inform every aspect of someone’s life, and are heartbreakingly real, but are still not accurate reflections of who they truly are.

Trauma twists someone’s story about who they are. Healing helps rewrite it.

“Polarization” in Internal Family Systems

Dealing with “polarization” between parts is a common occurrence in IFS therapy sessions. Through an IFS lens, challenging psychedelic experiences can often occur because these same polarized parts are amplified during a journey. Looping or confusion – a frequent element of a bad trip – might be seen as an extreme polarization.

Polarization is like an inner battle. A difficult psychedelic experience might occur because of this inner tension: one part wants to surrender, another part is terrified to do so. One part says to take a second dose, another part cautions against it. One part wants to lay down under a blanket, another wants to stand up, stretch, and go outside. Such conundrums can be viewed through IFS as polarized parts playing a psychic tug-of-war.

This can get exhausting. And usually, there is a much deeper process going on beneath. The IFS therapist’s job is to tend to the parts that arise with compassion, to witness them, help them unburden, and reconnect them to the energy of the Self.

“Blending” in IFS

We all have certain parts that become strong aspects of our personality. Many people who live outwardly successful lives might be plagued by a “manager” part which acts as a strict taskmaster, inwardly limiting their creative expression and spontaneity. High levels of anxiety, especially social anxiety, can be viewed through IFS as a “critical manager” or “worrisome exile” part which gains control in uncertain situations. Or someone struggling with a strong addiction, for example, can often revert to what’s called a “firefighter”–a reactive part that rushes in to dramatically protect the system when triggered, even though it ultimately sabotages that person’s wellbeing.

Such experiences are referred to in IFS as “blending.”

Fear of letting go, or becoming stuck in certain thought patterns is a basic example of being “blended” in a psychedelic state. The psychic energy being taken up by the part in question is inhibiting one from connecting to the body, the deep nervous system, and the Self, which is how healing most easily occurs.

Extreme examples of negative outcomes from psychedelics can often be seen through this idea of blending.

How many of us have experienced someone – possibly ourselves – fresh out of a psychedelic state convinced they are either some kind of messiah with a sacred mission, or at fault for some global catastrophe, disaster, or cosmic mishap?

Taken to the extremes, this is the stuff that psychedelic-induced psychosis is made of.

And almost guaranteed, there is a much deeper reason why the part in question took over. Likely, it is to protect the psyche from facing something incredibly scary or traumatic.

From a Jungian lens, one could view these extreme examples of blending as a type of “archetypal possession,” resulting from some form of inflation. During an archetypal possession, according to Jung, an archetype takes “hold of the psyche with a kind of primeval force and compels it to transgress the bounds of humanity. The consequence is a puffed-up attitude, loss of free will, delusion and enthusiasm for good and evil alike.

Interestingly, psychedelics can both inflate or deflate the ego, filling someone up with grandiose visions of spreading the “good news,” or reducing one into a fragile shell of themselves.

This is the critical role of integration: to recalibrate the ego with the Self, to witness and guide the vulnerable parts that need care, and to ground potentially expansive visions into a genuine path of tangible healing.

Using IFS to Navigate Psychedelic Journeys

Beyond integration, IFS can offer an immensely valuable toolkit for navigating psychedelic space as well. Speaking from personal experience, IFS has helped me to create more psychic spaciousness within a journey. Much like mindfulness, remembering my IFS training has helped me practice observing, rather than getting “hooked” into particular thoughts and feelings that might emerge during a psychedelic experience.

The basic premise of IFS is that the psyche is inhabited, and that we can learn to dialog with these presences or parts. Remembering this simple fact, I’ve been able to remain in a space of gentle curiosity when, for instance, I might fall into a thought pattern that could potentially send me down a critical, anxious, or confused internal loop during a journey.

Cultivating the ability to remain connected to Self, or any of the eight C’s which characterize this energy, helps me to remain grounded and present within psychedelic space. Much like mindfulness, the goal is to create psychic flexibility, spaciousness, and literacy, so that we might more deeply be able to do “the work” that psychedelics inevitably ask of us.

Every IFS therapy session, like every psychedelic experience, can be worlds apart. Speaking from experiences both as a therapist and client, I am continually blown away by what this therapeutic modality has revealed to me and those I’ve been lucky enough to work with.

As psychedelics are being embraced by the psychological establishment, and as these medicines collide with the demands of our capitalist economy, the need for highly trained, dedicated facilitators will become increasingly in demand.

Internal Family Systems is not only an effective psychotherapy modality with an extraordinary capacity to heal trauma, demonstrated in a pilot study in which 92% of participants no longer qualified for a PTSD diagnosis, it is also a non-pathologizing, client-directed, and ultimately psycho-spiritual framework for guiding one on the potentially infinite road of inner work.

As every good navigator knows deep down, the map and territory will always remain two very different realms. Yet as far as a set of directions for charting the inner world, and for helping people integrate potentially life-altering psychedelic experiences, Internal Family Systems therapy presents a toolkit which can greatly benefit therapists and facilitators looking for a detailed, multifaceted, and truly psychedelic methodology for exploring the soul.

By Sean Lawlor

The role of therapy in psychedelic therapy has been underexplored in mainstream articles that focus more on neuropharmacology and the psychedelic medicine experience. Without therapy, however, results from clinical trials would be no more significant than if the substance was studied in a recreational setting, and the fact that there is such a difference is central to the growing appeal. 

As our companion article on psychedelic therapy explained, numerous therapeutic approaches used in psychedelic therapy converge on an inner-directed, relational approach. In psychedelic sessions themselves, therapists take more of a back-seat role, encouraging clients to focus inward and engage in an authentic process facilitated by their “inner healer” and refraining from interpretation. Still, complications can arise in psychedelic sessions, such as an upsurge of trauma, and if therapists lack the skills to respond, they risk leaving clients stuck and unresolved, potentially re-traumatized from improper care in a vulnerable state.

While therapeutic training is essential in case overwhelming content arises, the bulk of therapy work occurs during preparation and integration sessions. Across numerous clinical trials and clinics offering ketamine and cannabis-assisted psychotherapy, psychedelic therapists are using many therapeutic approaches to help their clients heal. Here are some of the most common. 

Internal Family Systems

One of the most consistently referenced models used in psychedelic therapy is internal family systems (IFS). Developed by Richard Schwartz in the 1980s, IFS views the psyche as an amalgamation of interrelated personalities, or “parts” that often conflict with one another. IFS brings clients’ attention toward three main parts of the psyche: Exiles, Managers, and Firefighters. When these parts are in conflict, they prevent people from grounding in their core Self. 

Exiles are related to psychological trauma, often from early childhood. They are the parts that have been cast away- buried beneath shame, fear, or pain that has not been expressed or accepted. In psychoanalytic terminology, they have been “repressed.” Managers keep the Exiles in control, relegating them to their shadowy domain so they do not disrupt overall function. Still, Exiles sometimes break through Managers’ control, at which point Firefighters take over, putting the system on high alert and inciting reactive behaviors to avoid encountering the Exiles. All of these parts create the “internal family,” and IFS helps clients center in the Self, which transcends all the parts, to create a loving inner container for intrapsychic balance and communication.

“The goal of IFS is to first acknowledge these protected and wounded parts within a person, and then to foster this reconnection with the higher Self,” explained Jason Sienknecht, who practices ketamine-assisted psychotherapy in Fort Collins, CO. “Ultimately, the Self is put into a position of a manager so the other parts can fall in line behind the Self’s guidance, instead of monopolizing a person’s consciousness. We want the Self to monopolize the person’s consciousness.”

Sienknecht is a MAPS-trained MDMA-assisted psychotherapist and a lead trainer for ketamine-assisted psychotherapy through the Psychedelic Research and Training Institute (PRATI). In his psychedelic therapy work, Sienknecht regularly uses IFS. “The reason I gravitate toward IFS is because ketamine aligns the client with their higher Self, or inner healer, very naturally,” Sienknecht said. “The Self doesn’t need development- it’s the root of love and wisdom within each of us. Some people have lost sight of the Self through years of identifying with the protected or wounded parts of themselves.”

Sienknecht added that clients’ subpersonalities also naturally arise under the influence of ketamine, and IFS helps them make sense of the confusing content. As such, it is more a framework of integration than an intervention used in psychedelic sessions. “When you’re engaged in dialogue in a medicine session, you don’t want to give your client linear, logical reflections that their left brain can attach to,” Sienknecht said. “You want to encourage their non-linear state of consciousness to continue, rather than connecting them back to their thinking mind. I generally don’t bring my understanding of IFS into the dialogue of a medicine session.”

As a tool for psychedelic integration, IFS provides a powerful means to restructure one’s relationship to one’s inner reality for lasting healing to occur. 

Gestalt Therapy

Gestalt therapy preceded internal family systems as a predominant modality focused on internal parts. Created and developed by Fritz and Laura Perls in the 1940s and 1950s, Gestalt therapy helps clients enhance their present moment awareness through acute sensitivity to internal responses to stimuli. “Gestalt is a way to identify inner polarities within a person, or inner parts, and encourage dialogue between those opposing parts or beliefs,” explained Sienknecht. 

Those dialogues can take the form of the “empty chair technique,” in which clients converse with a part of themselves as if that part is sitting in the empty chair beside them. Clients are encouraged to feel and express the emotions that arise. Through the process, therapists help them expand their self-awareness and take more responsibility over their way of being in the world. 

Sienknecht recently facilitated ketamine therapy for a man suffering from alcoholism. A part of this man wanted to stay in a comfort zone and keep emotional pain at bay, which he did through binge drinking, while another part wanted to free himself from that addiction. Sienknecht helped him become aware of the polarity between these opposing parts, and from that awareness, the client could move toward resolving the conflict. 

Psychedelics can enhance clients’ awareness of the relationships and dichotomies between internal parts of themselves. Therapists have found that models based on accepting and balancing those parts can significantly enhance the healing potential from that newfound awareness. 

Somatic Therapy

Somatic therapy refers to body-focused psychotherapy. Somatic therapy is a relatively recent development without much research on its efficacy, yet it has still recently come to be regarded as one of the most effective approaches for healing trauma. Its foundational premise is that trauma is stored in the nervous system, and listening to the body’s messages is the ideal inlet to healing trauma’s lasting effects. 

The two most prevalent somatic methods are sensorimotor psychotherapy and somatic experiencing. Rafael Lancelotta, a psychedelic therapist and researcher practicing in Denver, CO, helped elucidate the differences. “Somatic experiencing is highly relational and has a ton of emphasis on resourcing,” he said. “Sensorimotor is more based on movement. It’s a little less relational; more let’s go into your body and see where these incomplete movements are. It’s more physical in nature.” 

The somatic style used by Innate Path, a psychedelic therapy clinic where Lancelotta worked for two years, is called trauma dynamics. Trauma dynamics uses elements of both approaches but focuses more on challenging clients outside of their window of tolerance. Lancelotta explained that while challenging clients can be effective, sometimes it can be too challenging and push clients too far outside their comfort zone. “I’ve found it most helpful to use pieces of all of these to find something that can be more fluid from one person to the next,” he explained. 

Since somatic therapy involves focusing on the body, it can be a helpful intervention in psychedelic sessions themselves. If therapists notice that clients appear stuck in their processing, they can invite the client to focus on their body and notice what arises. From there, new content can become conscious, allowing the client to move toward the point of stuckness and continue processing through it. 

Cognitive-Behavioral Therapy 

Many psychedelic therapists reject the efficacy of cognitive-behavioral therapy (CBT) and claim it does not lend itself well to psychedelic work. Nevertheless, one of Johns Hopkins University’s most significant psilocybin studies to date uses a framework of CBT- a study using psilocybin-assisted psychotherapy for smoking cessation. 

Dr. Matthew Johnson is the study’s principal investigator. While he explained that the psilocybin sessions themselves (which typically involve the synthetic equivalent of a Terence McKenna “heroic dose”) proceed with a non-directive, supportive approach, the many weeks of preparation and integration are CBT-focused. 

“In terms of the CBT, my thinking is that any number of empirically validated forms of therapy can be brought to bear here,” Johnson said. “If a tool tends to work for the disorder of focus, my bet is we can combine it with psychedelics and make it work. When you’re talking about smoking cessation, most of the programs and a lot of empirical support are based in CBT.”

CBT is among the most widely practiced therapies; used for depression, anxiety, PTSD, and addiction. Therapists help clients identify distorted thought patterns and then replace these cognitive distortions with new, healthier thought patterns, which correspond to better emotional regulation and healthier behavioral patterns. CBT has no interest in psychoanalysis and the unconscious mind. It is an action-oriented, solution-focused approach, and Johnson has found it particularly effective during the “afterglow” of a psychedelic experience. 

“We have a lot to figure out [about] what that afterglow is, but there’s probably some neuroplasticity lingering- this window of increased agency,” Johnson said. “If we then establish a new normal with boring, bread-and-butter techniques like CBT, it’s probably going to help.”

In the study’s ongoing second iteration, 59% of participants who received psilocybin were confirmed as abstinent from smoking in the one-year follow-up, as compared with 27% who received a nicotine patch. Such powerful results suggest that even modalities unconcerned with psychological depth can enhance psychedelics’ healing properties.

Mindfulness-Based Approaches

Mindfulness involves directing one’s open attention to present moment awareness. While this may seem like a given in therapy, many therapeutic approaches encourage interpretation and recounting of past experiences, both of which can impede awareness of the present. Mindfulness-based approaches to therapy, such as mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction, foster present-moment awareness as a path to healing. 

Sienknecht has found that mindfulness-based approaches align well with ketamine-assisted psychotherapy. “Ketamine quickly and effectively helps someone transition from the thinking self to the observing self,” he explained. “It just so happens that meditation does the exact same thing. Meditation mimics the activity of the higher Self, which some people refer to as the eternal witness. You’re not walking down the street, you’re aware of yourself walking down the street. It’s one step back from the ego. Mindfulness-based psychotherapy can help teach the skills needed to move more fully into this observing self.”

In order for people to move more fully into the witnessing Self, both inside and outside the psychedelic session, it is important they develop a daily mindfulness practice. “I find that people who practice daily throughout the course of a two-month ketamine treatment program are more able to move in the natural direction of the medicine as it moves you away from your thoughts and into an observing self,” Sienknecht explained.

A daily mindfulness practice does not have to be seated meditation. The practice can involve journaling, painting, exercising, or simply walking through the woods, as long as it is intentional time taken to practice awareness and receptivity to what arises within and without. 

The Hakomi Method

The Hakomi Method is a mindfulness-based somatic approach that is often discussed alongside psychedelic therapy. Developed by Ron Kurtz in the 1970s, Hakomi focuses clients on their present-moment experience and understands that the body is the harbinger of messages from one’s inner workings. Hakomi clients are encouraged to focus on mental content that arises alongside embodied sensations, such as images and memories.

Hakomi therapists use “probes” to gather information on a client’s internal process. These probes often aim at clients’ core beliefs that structure their relationships to their self and their world. For instance, a hakomi therapist might encourage a client to close their eyes, focus on their breath, and notice what arises as they say, “You are lovable exactly as you are.” It does not matter whether a client experiences elation and lightness, or bitter, self-defeating thoughts and constriction of the stomach- what matters is that the client notices what happens, because the response contains all the information needed to then work with the core content. 

Psychedelic sessions can cast new light on core stories while also showing clients that other stories are possible. Skilled Hakomi therapists help clients restructure and heal those stories’ ongoing impact on their present moment experience.

Experiential Therapy

Another present-focused approach is experiential therapy. Sara Reed spoke to the approach’s efficacy in her work with ketamine-assisted psychotherapy at the Behavioral Wellness Clinic in Connecticut, as well as her work in MAPS’ Phase II trials for MDMA-assisted psychotherapy for PTSD. “What that therapy is about is really focusing on what’s happening in the here and now,” Reed explained. “Often clients come in flooded with a lot of different things, and experiential therapy can help clients slow down and be present with what’s happening in the here and now.”

Experiential therapy can take many forms; those forms are united in that therapists involve clients in real, present-focused processes to gain insight into their thoughts, feelings, and emotional responses. Examples include art therapy, animal-assisted therapy, adventure therapy, and psychodrama. 

Michelle Hobart, a specialist in psychedelic integration, uses psychodrama with her clients. She described psychodrama as “an embodied enactment of certain scenes from life,” thereby allowing clients to engage creatively with their experience. “Creativity is a really important way of working with the material that arises,” Hobart explained. She often helps clients work with their psychedelic experiences as if they were dreams, focusing less on analytical processing than on “embodiment and active imagination.” This approach becomes especially important when psychedelic experiences cannot be rationalized or interpreted at all. 

Transpersonal Psychology and Spiritual Emergence

While transpersonal (meaning “beyond the personal”) psychology is not a modality, it is a broad wave of western psychology that embraces the validity of non-ordinary states of consciousness and understands humans as inherently spiritual. Academic programs in transpersonal psychology, such as those offered at Naropa University and Sofia University, are among the most popular programs for students interested in working with psychedelics. Understanding the expansive frameworks through which it views people can help therapists support clients through their most challenging internal experiences. 

An important topic within transpersonal psychology is “spiritual emergence.” Developed by Stan and Christina Grof, spiritual emergence refers to experiences in which individuals suddenly expand far beyond their established understandings of themselves into a broader perspective on the universe. When this process becomes too overwhelming, it can incite a “spiritual emergency,” which the western diagnostic model can misinterpret as psychosis. 

“Spiritual emergency is when something comes up that’s so expansive that it’s not able to be metabolized or integrated,” explained Hobart, who specializes in spiritual emergence in her integration work with clients. “Sometimes that opening is very ecstatic and blissful, and sometimes it’s terrifying and devastating. If we don’t have a framework for how to work with and hold spiritual emergence and emergency, then when that process happens; whether it’s catalyzed by medicines or happens spontaneously as through kundalini awakening or near-death experience, people may think it’s a mental illness or psychosis. Then people get sent into hospitalization, thrown into the pathology paradigm and forcibly medicated, and it’s not understood as what is actually happening.”

In honoring clients’ overwhelming experiences, Hobart helps clients integrate those experiences and adjust into a society that does not understand or appreciate their profound transpersonal expansion. “I hold it in terms of awakening to spiritual gifts,” she explained. 

Hobart also suggested that the potential for spiritual emergency in a psychedelic session heightens the need for therapists to be highly skilled and trauma-informed. “Some people who have been activated into these states have not been held properly in medicine spaces,” she said. “To be able to hold spiritual emergence and emergency, and for that matter, entheogenic work, people need to have attunement and the capacity to hold emotional and energetic space. And they need to be trauma-informed. That’s a huge piece.”

Conclusion

If anyone told you that being a psychedelic therapist is easy, that person lied to you. While specific regulations and training requirements are sometimes hazy and differ between medicines, psychedelic therapy calls for both responsibility and a diverse skill set for therapists to bring out optimal healing potential for their clients. 

These therapeutic approaches and frameworks do not comprise a complete picture of the approaches currently being practiced in psychedelic therapy. As Johnson suggested, it is possible, if not likely, that psychedelics can enhance any therapeutic specialty. Regardless, a robust therapeutic tool kit will help any psychedelic therapist meet clients’ specific needs. There is always more to learn, and psychedelic work has never been about staying within an established pattern or comfort zone. 

About the Author

Sean Lawlor is a writer, certified personal trainer, and Masters student in transpersonal counseling at Naropa University, in pursuit of a career in psychedelic journalism, research, and therapy. His interest in consciousness and non-ordinary states owes a great debt to Aldous Huxley, Ken Kesey, and Hunter S. Thompson, and his passion for film, literature, and dreaming draws endless inspiration from Carl Jung, David Lynch, and J.K. Rowling. For more information or to get in touch, head to seanplawlor.com, or connect on Instagram @seanplawlor.

By Jasmine Virdi 

Undoubtedly, psychedelics are valuable tools for self-understanding, transformation, and healing, enabling us to peer into our inner workings and understand the world around us in new ways. By nature, psychedelics are destabilizing as they facilitate non-ordinary states of consciousness, catapulting us outside the bounds of our everyday perceptions. They heal us by disrupting our normative flow of consciousness leading to a  multitude of insights ranging from the somatically strange to the mystically ineffable. 

But, psychedelics and the realizations they enable will not necessarily change your life if you are not committed to working with the experience afterwards. This step is known as “psychedelic integration” and it involves chewing on our experiences, digesting any insights, and taking practical steps to implement those insights as positive change.

Psychedelic researchers and psychedelic-assisted psychotherapists have long considered integration a key component in psychedelic healing. In fact, they place major emphasis on post-experience “integrative follow-up sessions” as a scientific approach to aftercare. Many believe that integration protocols and strategies play a crucial role in positive long-term therapeutic outcomes, and some even argue that the value of integration is greater than the psychedelic sessions themselves.

What Does Psychedelic Integration Mean in Practical Terms? 

Going on a psychedelic trip is a lot like physical travel. If you’ve ever gone backpacking or traveled for an extended period of time, you will know that returning home can often come as a major shock to the system, sometimes taking weeks—months, even—to re-adjust to our former lives. 

Similar to travel, psychedelic experiences can also shift our perceptions about the world, pushing us outside our comfort zones and into self-realization. Returning to our regular work-life patterns can be psychologically jarring, as we find ourselves irrevocably changed whilst everything we left behind remains the same. Thus, reshaping our lives to mirror the inward changes we’ve undergone can be profoundly challenging.

The psychedelic experience produces a spectrum of insights, ranging from personal to transpersonal to ecological. Sometimes a person will gain a new perspective on who they are, shifting the landscape around their professional purpose, intimate relationships, and lifestyles.

Psychedelic integration, then, is the process of weaving the practical with the mystical, taking profound, ineffable experiences beyond the temporality of the psychedelic state and grounding them in our day-to-day lives in the form of enduring, positive changes.

In this sense, integration is an active, intentional process where an individual consciously reflects on their psychedelic experience and what it means for them personally. It involves exploring how insights can be translated into bite-sized actionable steps. The personal nature of integration means that an individual needs to find an authentic way of implementing their experience in a way that suits their unique needs and personality.

After an initial revelation, the experience, materials accessed, and insights gained can quickly fade into a dreamlike memory or become psychically compartmentalized, getting lost in the busy pulse of modern life. Thus, it is important to carve out time to consciously work with these experiences.

Integration and the Importance of Pre-Session Intention Setting

Preparation and pre-session intention setting are critical components to integration. Returning to the metaphor of travel, preparing for a psychedelic experience is likened to all the work that goes into preparing for a long-distance trip. We would never go to the airport to catch a flight without the basic essentials: passport, money, a bag with at least the bare necessities, and a destination.

Similarly, setting an intention is akin to having a destination. It can provide a grounding anchor in a psychedelic session, helping guide an individual and give them a lens through which to process insights that arrive post-trip. Integration is unique to each individual — it’s inextricably intertwined with their reason for using psychedelics in the first place.

In the cult classic, The Psychedelic Experience, former Harvard researchers Timothy Leary, Ralph Metzner, and Richard Alpert write: “In planning a session, the first question to be decided is ‘what is the goal?’” Whether your intention is to heal from a traumatic experience, overcome addiction, deepen your connection to nature, or examine a specific aspect of yourself, it is important to know what you’re aiming for. 

According to clinical psychologist, psychedelic integration therapist and author of The Psychedelics Integration Handbook, Dr. Ryan Westrum, psychedelic integration is a continuous process similar to an infinity wheel in that “future stories will be cultivated, supported and benefitted if you are thinking about them prior.”

Another crucial element of preparation involves tending to your set and setting. “Set” generally refers to a person’s pre-session mindset. However, it can also include both immediate and long-range states of mind, covering everything from fears, hopes, and expectations about the session to personal history and enduring personality traits. The better the preparation, the more equipped an individual is to integrate their experiences.

The “setting” is the container of the experience. It factors into account when and where the experience will take place. In The Psychedelic Experience, the description of “setting” includes a temporal dimension, encouraging individuals planning for a psychedelic session to set aside up to three days to process their insights, so there’s “sufficient time for reflection and meditation.” The text cautions that returning to work too hastily will likely “blur the clarity of the vision and reduce the potential for learning.”

Similarly, Dr. Westrum advises:

“One could argue that the first hours and the days that immediately follow the psychedelic experience are the most crucial when it comes to integration. In general, our modern-day, contemporary lifestyles are so hectic, and we find ourselves constantly working, traveling and moving. It is important if you are considering taking a psychedelic, to take the proper time to do so, more appropriately thinking of it as a two-day experience. We need to carve essential time out to reflect and digest what happened, using the second day for purposes of integration.”

When considering healthy integration practices, it is essential for an individual to carve out the time and space needed for processing. Individuals are generally advised to avoid making any major life changes in the weeks that follow a psychedelic experience, and instead take time to rest, digest and distill insights before initiating dramatic changes.

Integration, Intuition and “Inner Healing Intelligence”

The concept of psychedelic integration is closely linked to “inner healing intelligence,” a notion originally developed by Stanislav Grof, and later refined by Michael Mithoefer, Clinical Investigator and Medical Director at the Multidisciplinary Association for Psychedelic Studies (MAPS). 

The notion of “inner healing intelligence” is built on the premise that nature is intelligent by design. For example, when we injure ourselves physically, bruising a knee or cutting a finger, our body automatically initiates its own sophisticated healing process. Just like a seed contains within it all the knowledge to become a tree, humans have an innate capacity to heal when they are in the right environment. Similarly, the psyche has its own innate healing capacity to extend towards wholeness. In the integration process, individuals are encouraged to connect with their inner healing intelligence and take responsibility for mending. 

The Emerging Field of Psychedelic Integration Therapy 

With the psychedelic renaissance in full swing and the resurgence of research illuminating the therapeutic potential of hallucinogens, it’s no surprise that the public opinion of psychedelics is beginning to shift.

But, the stigma around psychedelics still exists. For this reason, individuals who undergo psychedelic experiences outside of a psychotherapeutic or clinical paradigm meet challenges upon reentering their day-to-day lives.  The reason is that they usually have no one to openly share the experience with and no available resources to help sift through the intricacies of the trip.

Sometimes individuals need to reach out for professional support in order to digest the experience properly. Unfortunately, most mainstream therapists aren’t equipped to have a constructive conversation about psychedelics, however.  As a result, many patients feel reluctant to talk about their experience for fear of being judged.

This gap in the mental health system paired with the growing public interest in psychedelics creates a higher demand for psychedelic therapists. As a result, the number of professional integration therapists, coaches, and specialists is increasing. The newly growing subdiscipline of psychedelic integration has risen to prominence, creating a bridge between traditional psychotherapeutic practice and the “psychedelic underground” in which the two cross-pollinate. 

Many individuals who have not followed the institutional track to become an accredited mental health professional are emerging as practitioners within this space. But, what makes an individual qualified to be an integration expert?  To an extent, it seems that a bona fide psychedelic experience takes greater precedence than formal certifications. 

In choosing an integration therapist or coach to work with, integration expert Dr. Ryan Westrum expressed his concern over individuals falling into the wrong hands:

“Neo-integration therapists and coaches that don’t have a psychological background or a deep understanding of the world of consciousness scare me. There is beauty if calling something a ‘spiritual emergence,’ but if you start to recognize a person has suicidal ideation or chronic depression that didn’t break, you need healthy psychiatric and psychological support.”

He is careful to emphasize that beyond having the training to deal with such difficult scenarios, he believes “relationship is number one” and that ultimately “there needs to be a relationship established that feels safe, is psychedelic friendly, without judgment and is willing to hear where you need to go.”

Beyond psychotherapeutic and research paradigms, psychedelic integration is beginning to take root in the mainstream. Spanning across the US, there is now a variety of public integration circles emerging in the form of in-person and online groups. Psychedelic integration circles provide individuals who cannot afford therapy or private coaching a low-cost alternative. It gives them a judgment-free space to talk about their experience and provides access to a community that otherwise might not be there. 

Recognizing the growing need for psychedelic literacy in mental health, Psychedelics Today founders, Kyle Buller and Joe Moore, created an online course “Navigating Psychedelics For Clinicians and Therapists” especially directed at healthcare professionals looking to deepen their knowledge of psychedelic research and to support their clients with psychedelic integration. The next eight-week online course is currently open for enrollment, scheduled to begin on May 7, 2020. 

Is Integration Always Necessary?

I asked Dr. Westrum for his thoughts on the importance of integration after a psychedelic experience. Is it always necessary? He cautioned:

“It is never that you’re not taking enough medicine or not having enough experience. Rather, it is that you aren’t processing it appropriately. In 90% of cases, you look at people’s behaviors and lifestyles only to find they’re still stuck, they’re not taking what they are learning through psychedelic experiences and integrating it.”

It can be helpful to envision integration as existing on a spectrum or continuum. Four days of consecutive ayahuasca ceremonies will likely require more time for integration than a microdosing experience. Even if we feel that we don’t have anything that needs integrating, Dr. Westrum urges us to “at least process the experience at the level of ruling it out,” emphasizing that “everything deserves to be integrated into our lives.”

About the Author

Jasmine Virdi is a freelance writer, editor, and proofreader. She currently works for the fiercely independent publishing company Synergetic Press, where her passions for ecology, ethnobotany and psychoactive substances converge. Jasmine’s goal as an advocate for psychoactive substances is to raise awareness of the socio-historical context in which these substances emerged in order to help integrate them into our modern-day lives in a safe, grounded, and meaningful way.

Some interesting developments today in the world of Holotropic Breathwork & Dr. Stanislav Grof. Stan and his wife Brigitte issued a statement on Facebook about their moving further away from Grof Transpersonal Training (the Holotropic Breathwork trademark owner).

We wish Stan and his family the best of luck on this venture.

You can learn more about Stan’s current and future work here.
Learn more about their upcoming film here.