5 May 2023

Beyond Integrating Psychedelic Experiences

Beyond Integrating Psychedelic Experiences

By Marc Aixalà

MAPS Bulletin: Volume XXXIII Number 1 • 2023

It is incredible to see how psychedelic-assisted therapies are making their way into the mainstream at such speed. Not only are these therapeutic modalities being researched in clinical trials, but also different forms of psychedelic treatments and experiences are now being made available to the general public. These offerings include ayahuasca retreat centers in the Amazon, psilocybin-focused gatherings, ketamine clinics, legislation permitting the use of psychoactive botanicals for recreational purposes, the ongoing underground psychedelic movement, and many more.

Those interested in psychedelics can choose from a wide array of psychedelic practices and models that offer different approaches and experiences. In the Global North, society is becoming progressively familiar with MDMA-assisted therapy for the treatment of PTSD or psilocybin-assisted therapy and ketamine for depression. Most of the time these happen in a clinical setting, within a Western medical paradigm. This is generally seen as the most respected method by the general public. Mental health professionals and the lay public alike are interested in these treatment modalities, and also in becoming psychedelic practitioners. I receive weekly requests from people asking, “How can I become a psychedelic therapist?”

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But there are other contexts that have become equally popular. The interest in ayahuasca tourism has grown exponentially over the last decade. This, in turn, has increased the number of Westerners wanting to be trained in these traditions and become shamans, or curanderos. Neo-shamanic practices have become part of the current Western psychedelic framework. These modalities incorporate the use of ancestral practices and psychoactive plants into our modern worldview.

Psychedelics and psychoactive ethnobotanicals offer promising, innovative approaches to address human suffering. At the same time, psychedelic businesses and profit-oriented enterprises are presenting them as the new panacea, the Holy Grail of psychiatry and psychology. They portray miraculous cases of healing for those who lost hope after unsuccessful traditional psychiatric treatments.

Without a doubt, psychedelic-assisted therapy is capable of offering unsuspected relief to many people. We have developed safe and effective ways to provide these therapeutic approaches to a growing number of people. However, we have also seen that the psychedelic experience alone is often not enough to create a long-lasting improvement.

Over the last decade, I have worked as a therapist, Holotropic Breathwork facilitator, and provided psychedelic integration through the ICEERS Integration and Support Service. I have also worked as a psychedelic therapist in psilocybin trials for the past five years. Many people have reported immediate relief after a single experience in non-ordinary states of consciousness, no matter the way they got there. However, I have also seen how many times this relief faded away in the following days or weeks. It was already established in the seventies that the “psychedelic afterglow” tended to fade away if no further action was taken. It is challenging to watch people struggle when they discover this relief has been temporary.

Another scenario that has been even harder to witness is when people report feeling worse after a psychedelic experience. These cases, although not very common, do occur on a regular basis. The main work I did at the ICEERS Integration Service was to support people with the challenges arising after psychedelic experiences. I have worked with more than a thousand people since 2013 needing support to integrate difficult experiences. Most of the time, this was done over a series of talk-therapy sessions held online, although some were in person, and in some cases, just email communication.

The psychedelic community often talks about the importance of integration. More publications have appeared in the last couple of years on how to better integrate psychedelic experiences. My contribution to the emerging field of integration has been to create both an integration theoretical paradigm, as well as practical guidelines which can help therapists and integration providers expand their knowledge and skills. This initially took place via talks, conference presentations, and workshops for professionals and the general public (including traditional therapists, psychedelic therapists, and neo-shamanic practitioners). Some years later, I decided to collect this information and write a book exploring these topics. Psychedelic Integration: Psychotherapy for Non-ordinary States has recently been published by Synergetic Press.

The book outlines a history of psychedelic-assisted therapy, focusing on specific integration practices since this concept began to be used in the 50s. It offers an indepth description of what integration is by offering visual metaphors that depict different aspects and dimensions of psychedelic integration (cognitive, emotional, physical, spiritual, behavioral, social, and temporal). I explore a theoretical model for integration working with constructivism as the philosophical approach to integration which allows the therapist to adapt different worldviews and cosmologies that coexist in diverse psychedelic practices and beliefs. The reader can then find a description of the seven main scenarios or challenges that people experience after difficult psychedelic experiences based on what I have encountered in my practice. These scenarios are:

1. a lack of preparation

2. difficult,unresolved experiences

3. traumatic experiences with dissociation

4. problems with facilitators/shamans

5. previous psychological disorders

6. repeated consumption without integration

7. the emergence of previously unknown traumatic memories

I also propose specific ways to support people in each of these scenarios.

What often comes to mind when discussing integration is the focus on integrating a specific experience. This approach centers on how to find meaning in a given journey. Most integration approaches and activities focus on this. While this is important to pay attention to, I believe the goal is to work towards more comprehensive practices.

Integration is part of a wider process that includes the preparation for the experience, the session itself, integration, and many times, specific therapy. These different parts are interrelated. The overall results of psychedelic-assisted therapy will depend on what has happened in each phase.

My current interest and clinical practice seek to understand what works best and offers the ideal support to people. We can explore what kind of preparation and therapeutic practices should be offered as part of an ongoing therapeutic process that may involve psychedelics at some point. I constantly try to assess which integration practices are most useful in each given case.

One of the current challenges in the field of psychedelic-assisted therapy is to understand the psychedelic experience not as a single event, but as a part of a greater process. The pioneers of early psychedelic research, as well as spiritual teachers who were acquainted with psychedelics, saw them as catalysts of change. They were viewed as the beginning of an unfolding process, not the end of it.

This is a challenge for modern society that seeks immediate, simple solutions to complex problems, clear answers instead of uncomfortable questions, and quick fixes as opposed to being open to the process of ongoing work.

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For me, the main lessons of psychedelic experiences are responsibility, accountability, and agency. Through these experiences, we discover that there’s no need to surrender our power to someone else. Instead, we recognize that growth and healing are inside of us. This is perhaps one of the greatest lessons that psychedelic substances offer.

Developing integrated practices that honor this core principle should be the focus of our global community now that psychedelic experiences are not something so extraordinary.

Marc Aixalà

Marc Aixalà is a telecommunications engineer, psychologist, psychotherapist and certified Holotropic Breathwork facilitator specializing in supporting people who face challenging experiences with expanded states of consciousness. Since 2013, in collaboration with the International Center for Ethnobotanical Education, Research and Service (ICEERS), Aixalá has offered integration psychotherapy sessions for those seeking support after psychedelic experiences. At ICEERS, Aixalà also works to develop theoretical models of intervention and trains and supervises therapists.

Aixalà has served as a team leader and trainer in emergency psychological assistance at Boom Festival through the Kosmicare harm reduction program. He also worked on the first-ever medical trial on the use of psilocybin for treatmentresistant depression, a study chronicled in the 2018 documentary, “Magic Medicine.” He continues to work as a therapist in clinical trials researching psychedelic substances.

Aixalà is trained in the therapeutic use of Non-Ordinary States of Consciousness and in the use of psilocybin for Treatment Resistant Depression, as well as in MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD) by the Multidisciplinary Association for Psychedelic Studies (MAPS). Aixalà works as a psychologist in his private practice in Barcelona, Spain and offers trainings, lectures, and talks related to psychedelic psychotherapy and integration.