A Harm Reduction Approach to Psychedelic Psychotherapy:  Understanding the Importance of Integration for Healing in Mental Health

Psychedelics have got a lot of attention of late with much hype on social media.  People are sharing personal stories of larger than life transformations, attributing psychedelic use as responsible for curing major mental health issues like treatment resistant depression and complex PTSD.  These stories offer hope to people who have experienced much suffering throughout their lives. What they don’t communicate is the risks and challenges that go along with accessing expanded states of consciousness to facilitate healing. 

As a psychedelically informed psychotherapy practice, we believe that it is important that people considering psychedelic integration psychotherapy are informed about a harm reduction approach and consider the safest pathways towards healing.  All of these questions are considered and addressed in the process of “integration” which we believe is the most important part of the healing process in psychedelic assisted therapies.

What are Expanded States of Consciousness?

One of the major misconceptions about psychedelics is that the medicine and experience alone is what facilitates change.  Once we scratch the surface of what psychedelics really are, we begin to understand that it’s very complex and complicated when it comes to healing.  There are many different forms of psychedelic medicine in plant and chemical form, each with their own chemical and energetic signature.  What is common to all of them is that they bring about a change in consciousness that is different from our everyday experience. These are expanded states that put us into connection with a healing capacity through open heartedness, deep compassion, connection to the present moment, embodied awareness, and imaginal realms that we can also experience in dream or trance states. 

Psychedelic medicines have been used responsibly in healing cultures for thousands of years and continue to be integrated into indigenous ceremonies for spiritual healing throughout the world.  Many of these traditions have not used or relied exclusively on plant medicines, but also integrate mind/body practices that include breathing, dance, music, chanting, visualization and meditation with trained elders to support these healing experiences in community.

Dr. Stanislov Grof, a Czech psychiatrist who is a pioneer in psychedelic medicine for over 60 years, understood this distinction and developed a natural method for accessing expanded states called holotropic breathwork.  Holotropic means “moving towards wholeness” and this method was developed when the use of psychedelics became illegal in the 1970s.  It is a powerful tool that does not require a special license or prescription to use.  However, it does require that people using breathwork for healing understand and appreciate the power of this method and approach it with respect and reverence. 

One can be surprised (or disappointed) with what can open up in these deeply profound experiences. For this reason, it is important that people spend a lot of time in reflection and conversation about the intention and insights that come from holotropic or expanded states of consciousness.  This process is also known as psychedelic integration, and can be part of a transformational experience that one undergoes for psychological and/or spiritual reasons.

Integration of Expanded States for Mental Health

In a licensed mental health clinic setting psychedelic integration psychotherapy is approached from a bio/psycho/socia/spiritual lens.  We also use the language of “harm reduction” which is a different definition from how it is used in the field of substance misuse and addiction.  The traditional definition of harm reduction is “an evidence-based, client-centred approach that seeks to reduce the health and social harms associated with addiction and substance use” (CAMH).  Implied in this definition is that psychedelics cause harm rather than healing and client choice is faced with non judgment and acceptance. 

Our legal and professional standards do not allow us to condone illegal drug use and psychedelics can only be used above ground with a trained, licensed physician.  It puts us non-prescribing mental health professionals in a tricky place.  We have to use a language that does not respect the healing potential of these medicines. We have to work collaboratively with a medical provider who is trained and willing to prescribe and oversee this work, adding to the complication and cost. 

It also forces us to align with a biomedical model which may not actually fit with the paradigm of healing in mental health that happens in non ordinary states.  It is a very different from the diagnostic model of pharmacology which emphasizes symptom reduction through medication use.

One way to work around this issue, is to place less focus on psychedelic medicine for healing and emphasize more accessible and subtle practices mind/body that support expanded states for healing including the process which we call “integration”.

Integration is the work we do to prepare for a journey, to make sure we are clear about our intentions and what we need to do to prepare for transformation.  It is also the work that we do after the sessions where we process what we have learned and discover what changes we need to make in order to live more in alignment with our values.  Integration is a life long process but it can be more focused and intentional around times when we decide to enter into expanded states of consciousness at certain times in our lives when a change is needed.

A Group Psychoeducational Approach to Integration

There are many approaches to integration including individual work like journaling/creativity, working with a spiritual guide, a close friend, or a psychedelically or spiritually informed therapist.  Groups can also be a very powerful approach to integration, especially for those who are new to this way of thinking about healing in mental health.

Psychoeducational groups are a safe way to enter into this space and feel the benefit of learning in community with others.  It is different from a therapy group where people may share more personal details of their lives.  In a psychoeducational integration group, one does not even need to share if they are using psychedelic medicines or not. The common experience is an expanded state that is transformational in some way, whether it be above ground or underground with plant medicine, or through natural methods.

The structure of this group is simple and practical with four sessions on themes related to integration.  It can be relevant to people new to the experience of expanded states, those considering them or those with experience and needing deeper community connection and structure for reflection.  (We will not give advice or spend any time giving advice about psychedelic medicines and how to access them.  This information is easily found on the internet.) 

We look at change through a somatic lens and integrate simple, daily mindfulness practices to help us live from a more present focused, embodied place.  Spiritual language is welcome but not necessary as not everyone resonates with this language.  We use this space to discover a language that is inclusive of all experiences and to build as a foundation for ongoing integration and work with expanded states of consciousness beyond the container of this four week group.

If you are interested in learning more about psychedelic psychotherapy, harm reduction, and integration, please consider joining us for a free “ask me anything” online session on Jan 22, 2024  For those who are ready to dive deeper into this work, please sign up for our inaugural 4 week integration group in March.