Integration has become a buzzword in the world of psychedelics, but there are still questions being asked about what it means to be integrated, who can do it, and how it can be done. As a clinical psychologist and practitioner of Eastern spiritual traditions, I have been contemplating the role of the ego for more than two decades. In psychology, the ego is something to be integrated. From the wisdom practices of the East, the ego is something to be transcended. As an increasing number of clients are approaching me about their use of psychedelics, I am left with the task of preparing and supporting them for altered states of consciousness where the ego has seemingly been dissolved. So, from these various perspectives, what does meaningful integration look like?
We know from the FDA-approved clinical research protocols with psychedelics that integration is the term being used to describe psychedelic aftercare. In these clinical trials, participants typically start with one to two preparatory sessions with an experienced therapist, advance on to experimental sessions with a particular psychedelic medicine (e.g., MDMA, psilocybin), and have one to two follow-up sessions called “integration sessions,” where they assimilate the material that came up while under the influence of the medicine. Based on the data from these clinical trials (and more than six decades of psychedelic research), integration sessions are believed to be a critical component of the psychedelic experience. However, the majority of people who will use or have used psychedelics in their lifetime will have done so independent of these clinical trials. For some, psychedelic experiences are enlightening and transformative. For others, they are confusing. Sometimes, if consumed in a set and setting that isn’t supportive, they can be downright traumatic.
Medicine Ceremonies and Non-Clinical Use
With increasing frequency, Westerners are making their way to plant medicine ceremonies using substances like ayahuasca and San Pedro cactus, where traditional practices may or may not include formal integration. Perhaps more frequently, people are experimenting with psychedelics independently, without education about the importance of set and setting and without the therapeutic container of support that constitutes the integration process used in the clinical trials. In response to this issue, we are seeing an increase in integration circles and integration groups in community-based settings, where people are coming together to discuss their personal experiences with psychedelics. Often, just the act of being in community serves a major function of integration. Unlike the indigenous communities in which these practices originated, the use of plant medicines is not an integral part of our cosmology, our identities, or the fabric of our social lives. Our experiences with psychedelics are often difficult to talk about, particularly with family and friends who have not experienced the medicines themselves. We, as Westerners, are often lacking in communal support and in our regular access to the natural environment. Therefore, there is a real need for culturally relevant ways of integrating psychedelic experiences into our modern lives.
Psychology and the Ego
Integration is a vital component of traditional psychotherapy. From a purely psychological perspective, integration involves a reuniting of the parts of ourselves that have been split off, banished from consciousness, deemed unfit or unsafe to acknowledge, experience or express. This fragmentation of the personality and of the psyche leads to a host of mental health problems and disorders and interpersonal relationship difficulties. When the identity, or sense of self, is impoverished or unstable, a person will experience excessive self-criticism, chronic feelings of emptiness, and dissociation (a state of disconnection from mind and body). In psychotherapy, we focus on the integration of the ego and the development of a continuous and stable sense of self. Ego is a Latin word that means “I.” When a person has an integrated ego, they have a reliable sense of their “I” and of their personal identity. They also have a reliable sense of others as distinct from themselves and an understanding of how these two constructs (self and other) interact to form a sense of reality. The integration of the ego is the process of organizing the aspects of the personality (drives, attitudes, beliefs, goals) and the split off parts of ourselves (due to shame, pain, trauma, etc.) into a balanced whole. In so doing, we become more effective in managing our lives and our relationships with others.
The Significance of the Mind-Body Connection in Psychotherapy
When trauma is involved, and often times when it isn’t, we human beings tend to cope by splitting off our awareness from our bodies. In The Body Keeps The Score, Bessel Van der Kolk1 talks about the disconnection that happens between the right and left brain when we’ve experienced trauma. The right brain, responsible for emotional and sensory information processing, becomes overwhelmed and the left brain, the home of logic and reason, shuts down. In these moments, people are often unable to speak or utilize words to express themselves in an effective way. People become flooded with sensory information and react emotionally, by fighting, fleeing, or freezing. Integrating or rebalancing these two sides of the brain requires being able to tolerate those sensations and the feelings they evoke. Van der Kolk says that traumatic memories are stored in sensory and emotional fragments and are not organized into a coherent, logical narrative. Healing from these traumatic memories requires being able to access them in order to construct a meaningful story that can be digested and assimilated.
Spirituality and the Ego
In contrast to the psychological process of integrating the ego, many spiritual traditions focus on transcending it. This means to go beyond the range or the limits of the ego. This is because, when we identify with the ego, we automatically consider our individual self to be separate from others, from the natural world, and from something bigger (e.g., God, Brahman, the Universe, cosmic consciousness, etc.) This is due to the individual’s identification with the mind, the physical body, and the five senses that inform it (sight, sound, taste, smell, and touch). When spiritual awakenings happen, the individual begins to realize that they are more than just their bodies, their sensations and emotions, and their thinking mind. This can be both liberating and terrifying, and often requires a set of practices such as yoga, meditation, and breathwork to help us manage being in this world while not being of it.
Psychedelics and the Ego
Considering the psychological and spiritual understanding of the ego is important when structuring the modern integration of psychedelic material. Some common features of psychedelic experiences include a heightening of physical sensations, emotions, and memories; some of which may be traumatic. Other common features of psychedelics involve the dissolution of the ego where we lose the conscious, everyday sense of ourselves with which we are primarily identified. This may involve visions and feelings of being transported into other mystical and mythological realms. On high doses of psychedelics, it is common to experience a sense of oneness with everything and everyone, or a state of “being-ness” that is ineffable or impossible to describe. So, while integration in psychotherapy involves creating wholeness within the ego, and integration in spiritual practices involves bridging the ego with that which lies beyond it, the integration of psychedelic experiences requires a weaving together of material from both of these places.
Psychedelic Integration: Who Can Do It and How Is It Done?
With a basic understanding of what integration is and why it is useful, we are left with the question of what activities constitute integration, and who can provide it. Can it be done in psychotherapy? Yes. However, psychotherapy is just one of many methods that is suitable for integration. While psychotherapists are trained to strengthen the functioning of the ego so we can survive our everyday reality, it is important to find a professional who understands the medicines and how they work. Is it group sharing? Yes. Ideally, group sharing is done with facilitators, who may be from a variety of professional backgrounds, but who also have solid experience and understanding of the medicines and how they work. An important element of sharing in groups is the therapeutic concept of “universality,” where people come to recognize that they are not alone in their experiences. Listening to the experience of others can normalize the experiences we’ve had ourselves. Can it be done alone? Yes. Ultimately, each of us has our own inner healer and inner healing wisdom, and the work of integration is both our right and our responsibility. Sometimes it involves reaching out for support from professionals, spiritual leaders, and like-minded explorers. Other times it is enough to engage in some integration practices on our own. Is it being out in nature? Yes. This is also an inherent element of the indigenous medicine traditions where people live and commune outdoors and are equally connected to the plant and animal world. Is it creating artwork? Yes. Through talk therapy, we can rewrite the story of our lives by reflecting on how issues and traumas are still being experienced, and on the various parts of ourselves that have shut down. However, with psychedelics, much like with trauma, language may not be available to express what we’ve experienced, nor is it necessarily the best or most effective way to express it. Drawing and painting and working with mandalas are great ways to express nonverbal material. Is it movement? Yes. If traumas and distress are located in the body, and they always are, somatic practices can be helpful. What affects the mind affects the body, and vice versa. Becoming embodied and aware of the breath while moving through sensations helps us to integrate on the physical level. Is it mindfulness? Emphatically: Yes! It is through an increased awareness of the body, the mind, and the spirit that we become whole.
When Should it be Done?
With psychedelics, many insights and visions will eventually fade like a dream. Therefore, it can be a good idea to initiate the process of integration right away. Oftentimes the first thing we can do after a psychedelic journey is to simply rest so that the medicine and its teachings can continue to unfold within us. If it’s late, the best first step may be to get some sleep, where the brain can regenerate and the psyche can begin assimilating new insights. If sleep isn’t readily available, it might be enough to practice stillness, ideally in nature or in water (including a soothing bath). There may be a need to first record aspects of the journey through journaling, writing and drawing, and also practicing mindfulness through meditation and breathwork, or through somatic practices such as yoga, tai chi, or rhythmic dance. When the time is right, the process of sharing can be done in a community of like-minded explorers, and with facilitators or psychotherapists who are able to hold space.
Integration is the process of becoming whole. In psychology, we integrate the ego. We reconnect the fragmented parts of ourselves that have been split off or exiled because of the shame and the pain that they hold. These are the parts of ourselves that we don’t like; the parts that are vulnerable and afraid. However, in burying these painful parts of ourselves, we inadvertently also bury the other more joyful parts of ourselves. If we numb our fear, we numb our joy. We drink and abuse substances of all kinds to numb the pain or to feel something else or nothing at all. We constantly shift the external experience when the current one overwhelms us. This means we aren’t being present. We aren’t still. Integration is about collecting all of the parts of ourselves and weaving them back together like the multifaceted diamonds that we are. We are like diamonds that shatter in response to trauma and difficult life experiences, fragments chipping off with each blow. The work in traditional psychotherapy is to unite, or integrate, the various parts of ourselves into one brilliant whole. By bringing awareness to the various parts of ourselves (the mind, the body, the breath, the senses) they can become integrated. By integrating these parts, we come to observe our identity and our egoic sense of self. In many spiritual traditions, it is then through disidentification with this ego that we come to realize our true nature. This is our very essence, and what many people feel fortunate to experience on psychedelics. Just as we benefit from the integration of our psychedelic experiences, we may also become personally and spiritually integrated as a result of having used them.
- Van Der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York City, NY: Penguin Books. ↩