Psychedelic integration support
Psychedelic integration support is clinical work with people who use, or are considering, psychedelics. Ingmar Gorman, Elizabeth Nielson and colleagues describe it as a transtheoretical clinical model, published in 2021. Trials of psilocybin given with psychological support have been published, but those trials test psilocybin-assisted therapy, not integration support on its own. IX Coach can talk about this approach; it does not deliver it.
What it is
Psychedelic integration support is clinical work with people who have used psychedelics or who are considering using them. Gorman and colleagues describe it as a transtheoretical and transdiagnostic approach, which means it draws on several psychotherapy frameworks and is not tied to one diagnosis.
The field brings together harm reduction, which concerns safety around use, and integration, which concerns what happens after an experience. Pilecki and colleagues (2021) write that therapists have an ethical duty to support people who use psychedelics, and that this work carries some risk because psychedelics are prohibited in most countries.
Where it comes from
Gorman and colleagues (2021) published the transtheoretical model in Frontiers in Psychology. The authors describe the model as timely, given recent law-enforcement deprioritisation of psychedelics and compassionate-use approvals for psychedelic-assisted therapy.
The principles underneath
Work with the person, in any context
The model applies whether a person uses psychedelics in a clinic, in research, or on their own. The focus is on the person rather than on one setting.
Harm reduction and integration together
The model pairs harm reduction with integration, so that safety around use is part of the same clinical work as making sense of an experience.
Legal and ethical limits shape the work
Because psychedelics are prohibited in most countries, clinicians must weigh legal and ethical risk. Pilecki and colleagues (2021) discuss these ethical and legal issues in detail.
How a session runs
- The person meets a trained clinician to talk about an experience they have had, or one they are considering.
- The clinician asks about safety first, including current health and mental health history.
- The two look at what the experience brought up, in the person's own words, without rushing to a single interpretation.
- They discuss what the person wants to do next, including whether to stop, change or continue use, and what the law allows where they live.
- Follow-up sessions track how the person is getting on in daily life, and whether support is still needed.
- Where the situation calls for it, the clinician refers the person to other care.
When it tends to fit
- You have had an experience with a psychedelic that you keep thinking about and cannot yet put into words.
- After a session in a legal or clinical setting you feel unsettled, and you want someone trained to talk it through with you.
- You are considering a psychedelic experience and want to think through safety with a clinician before deciding anything.
What the research shows
Evidence: Practitioner tradition — little or no outcome research
No study found in the searches for this page tests integration support on its own. The peer-reviewed trials that were found test psilocybin given within a treatment that includes psychological support, so they are adjacent evidence rather than tests of this approach. Carhart-Harris and colleagues (2016) published an open-label feasibility study of psilocybin with psychological support for treatment-resistant depression. Griffiths and colleagues (2016) published a randomized, double-blind, cross-over trial in patients with life-threatening cancer, and Ross and colleagues (2016) published a randomized controlled trial in patients with cancer-related anxiety and depression, in which the psilocybin was given in conjunction with psychotherapy. Yaden and Griffiths (2020) argue that the subjective effects of psychedelics are necessary for their enduring therapeutic effects. Olson (2020) argues that they may not be. The two papers were published together, and the question is open.
Where the evidence is thin: The trials test psilocybin given within a treatment that includes psychological support, in people with cancer-related distress or treatment-resistant depression. None tests integration support as a stand-alone service, so they are adjacent to this page rather than tests of it, and the page is graded P for that reason. The Gorman and colleagues paper is a clinical framework, not an outcome study. Legal status varies by place and changes over time.
Sources
- Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Frontiers in Psychology, 12.
- Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18(1).
- Carhart-Harris, R. L., et al. (2016). Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. The Lancet Psychiatry, 3(7), 619–627.
- Griffiths, R. R., et al. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12), 1181–1197.
- Ross, S., et al. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of Psychopharmacology, 30(12), 1165–1180.
- Yaden, D. B., & Griffiths, R. R. (2020). The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects. ACS Pharmacology & Translational Science, 4(2), 568–572.
- Olson, D. E. (2020). The Subjective Effects of Psychedelics May Not Be Necessary for Their Enduring Therapeutic Effects. ACS Pharmacology & Translational Science, 4(2), 563–567.
Where it stops
Psychedelic experiences can bring up intense material, and some health conditions make use unsafe. A qualified clinician should assess these before anyone acts on them. IX Coach does not give dosing, sourcing or safety instructions for use.
Legal status varies by place. Pilecki and colleagues (2021) note that psychedelics are prohibited in most countries, so any support has to be weighed against the law where the person lives.
If someone is in crisis, or thinks about harming themselves or others after an experience, contact emergency services or a crisis line now. Do not wait for a session.