Elizabeth M. Nielson, Ph.D.

Elizabeth M. Nielson, Ph.D.

Elizabeth M. Nielson, PhD, is a Psychologist at the Psychedelic Education and Continuing Care Program and therapist on clinical trials of Psilocybin and MDMA-assisted psychotherapy.
Elizabeth M. Nielson, Ph.D.

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The Psychedelic Education and Continuing Care Program (PECCP) is intended to help meet the needs of people who are seeking additional support around psychedelic use in any context

Psychedelic experiences have an unpredictable place in psychotherapy; some therapists are openly comfortable discussing them, and others are worried by the mere thought of their patients engaging in psychedelic use. True, psychedelics have a history of use in mental health treatment, and several are currently being tested as part of psychotherapy protocols for a range of diagnoses, but there is still little precedent for integrating people’s experiences with psychedelics outside of the psychotherapy setting into the course of psychotherapy. This can be problematic for people who have had intense, difficult and/or positive, life-altering psychedelic experiences, who then feel they must gloss over, hide, or even deny these experiences in order to participate in psychotherapy. How can psychedelic experiences be invited into the psychotherapy setting in a helpful way? One way is through psychotherapy that includes psychedelic harm reduction and integration. The Psychedelic Education and Continuing Care Program (PECCP) is intended to help meet the needs of people who are seeking additional support around psychedelic use in any context, including reducing risks and potential harms of psychedelic use. The PECCP offers trainings for clinicians, individual consultations and psychotherapy, and the psychotherapy group I’ll describe in this article.

Basics

The Psychedelic Harm Reduction and Exploration Group (PHRE Group) is a psychotherapy group I started and run weekly at the Center for Optimal Living in NYC. I meet individually with all participants before they join the group; this helps me understand each person’s unique needs, motivations, and goals, as well as answer questions and ensure understanding of what to expect in the group. Group members may or may not have used psychedelics; some are contemplating using them, and others have extensive experience. The common thread is an interest in the potential for safe and responsible use of psychedelics. Participants tend to be cautiously curious, recognizing both the potential benefits and limitations of psychedelics, and hope to achieve greater benefit and reduce risks through education, careful preparation, and integration in a supportive group setting.

Psychedelic Harm Reduction

is a philosophy and set of principles that aims to reduce harms related to drug use

Harm reduction, broadly defined, is a philosophy and set of principles that aims to reduce harms related to drug use, such as health problems related to how drugs are consumed or unsafe behavior while intoxicated. Harm reduction involves a commitment to each person’s unique goals, strengths, and needs; respecting autonomy and empowering people to make healthy, life-affirming choices. A harm reduction approach is one of curiosity and compassion that honors a diverse range of goals and experiences. Harm reduction work with people who use psychedelics looks different from harm reduction around the use of other drugs because the harms associated with the use of psychedelics tend to be minimal and isolated to the individual, whereas harms associated with drugs like alcohol, cocaine, and heroin affect the individual and their community quite broadly, resulting in loss of productivity and interpersonal difficulties, and have greater potential for health consequences. Still, there are some safety concerns with psychedelics, such as drug combinations and side effects, risk of legal problems, and stigma associated with use. Harm reduction around psychedelic use may include topics such as drug interactions and testing drugs for contaminants, planning for safety during upcoming experiences, and connecting with others to lessen experiences of stigma and isolation.

Psychedelic Integration

where the participant takes a psychedelic in the company of two psychotherapists they have worked with on preparation and will work with afterward for integration sessions

A psychedelic experience can lead to great shifts in openness, spirituality, and motivation. These changes may result in a new perspective on one’s life, problems, even the nature of reality. They can be a catalyst for changing addictive behaviors, healing from trauma, or resolving depression. In most research studies, these types of changes are the result of psychedelic-assisted psychotherapy, where the participant takes a psychedelic in the company of two psychotherapists they have worked with on preparation and will work with afterward for integration sessions. In the research settings, the integration sessions serve to help the participant make sense of the psychedelic experience, provide support for making behavioral changes (e.g., reducing alcohol consumption), and monitor for any emerging complications or difficulties. What we provide at the PECCP program is not psychedelic-assisted therapy, since we are not providing any psychedelic sessions. However, we can incorporate some of the same principles, such as openness and curiosity about our program participants’ psychedelic experiences, recognition of their potential value for growth and positive change, and space for respecting spiritual, mystical, and transpersonal experiences that may be undervalued or ignored in other settings.

To this end, it seems to be helpful if people can have intermediary experiences that are opportunities to re-access the states and insights they experienced while on a psychedelic, but in a milder or shorter form, and without the actual psychedelic compound as an impetus, to help bridge the gap between the psychedelic experiences and the daily reality they live in. Most participants come to the group with an established meditation practice, yoga practice, or other spiritual practice that informs their understanding of psychedelic experiences. These can be used in conjunction with psychedelics to enhance the effects of each, or separately as integration practices. Furthermore, they can serve as a framework for contextualizing insights such as experiences of interconnectedness or of past lives. Hindu and Buddhist texts on the nature of reality and human experience are one such example of a rich resource and point of reference that participants may draw on.

Psychotherapy Group

First, members are not peers in another community; they are not colleagues, family members, etc. They don’t have pre-existing relationships and aren’t there to socialize or make friends

The concept of group psychotherapy, sometimes called a process group, includes several unique principals. First, members are not peers in another community; they are not colleagues, family members, etc. They don’t have pre-existing relationships and aren’t there to socialize or make friends. This means participants’ relationships within the group are unique; they can support each other without disturbing or worrying about their other roles outside of the group. Second, the group offers an opportunity to recreate one’s typical social roles and psychological patterns in a safe space where these can be explored. This offers an opportunity to learn about things such as common communication patterns and individual tendencies for certain interpretations, which may or may not match the speakers’ intention. Participants can also draw attention to their own experience in-the-moment, noticing how they are feeling about things, and the experience of talking about them, the emotional tone that arises, and thoughts that might otherwise not be expressed. Because group members have a relationship with each other that is entirely dedicated to this group process, they can engage more fully in this type of work.

Set and Setting

The psychotherapy group is a unique setting, in which participants enter a distinctive mindset. Here, the set is created by the relationships with the therapist and group members. The setting is a private psychotherapy office, a quiet and comfortable space that neither invokes nor dissuades references to shamanic tradition, a particular religious belief system, or another culture with which psychedelic use might be associated. I see it as one of several potential settings in which psychedelic integration work can take place, one that holds some unique benefits, but also may not be the right fit for everyone. Furthermore, because the space is not the same one in which participants have used psychedelics, it may be unlikely to elicit strong memories or re-experiencing of those experiences. From an integration perspective, this can be both a challenge and an advantage; participants are practicing accessing the insights of their psychedelic experiences in other settings without reliance on strong external cues. Finally, the presence of a mental health professional experienced in psychedelic-assisted therapy and research further emphasizes the legitimacy of psychedelic experiences as topics of discussion in mental health care settings.

Putting it Together

A psychedelic experience does not necessarily translate into great shifts in openness, spirituality, or motivation, improved health outcomes or better overall adjustment, but it can be a catalyst for such things

When people ask me what psychedelic integration is, I often refer, at least in my mind, to Huston Smith’s comment that a spiritual or religious experience does not make a spiritual life. The same could be said of psychedelic use. A psychedelic experience does not necessarily translate into great shifts in openness, spirituality, or motivation, improved health outcomes or better overall adjustment, but it can be a catalyst for such things. The PHRE group is about putting the experience into play. It is the part that bridges the learning to real-life application. For instance, if someone has just had a psychedelic experience and seen—really experienced—that time is an illusion, how do they apply that? How do they put that into practice? In the PHRE group, they would have the opportunity to talk with others who have had similar insights, who perhaps also notice subtly feeling less pressured and rushed by the clock and more trusting that things will fall into place in their own time. Where there is recognition of the potential value of these experiences, their application can unfold.

Likewise, if one goes on a meditation retreat, one might come home feeling quite relaxed, and also have some fairly profound insights about the nature of the mind, but it is easy to forget all that in a few days and quickly revert to one’s normal stressed-out state. To continue to bring those changes into your life takes daily practice, continued exposure to teachings, and, usually, the company of others who are doing the same. I think psychedelic integration is similar. It is helpful if people can have intermediary experiences, practices that help them re-access those insights to help bridge the gap to the daily reality they live in, and have a chance to discuss these in supportive company.

Part of the Big Picture.

for integration might be appropriate for someone who had particularly difficult or traumatic experience during a psychedelic journey, someone with pre-existing mental health concerns, or someone who does not have or may not want any connection to a community of other people who use psychedelics together

The institution of a psychotherapy group as a space for psychedelic integration should not be taken to imply that everyone who has psychedelic experiences needs to be in psychotherapy, or even should be. This particular set and setting is only one of a number of options open to those seeking integration and aftercare. For instance, a psychotherapy setting for integration might be appropriate for someone who had particularly difficult or traumatic experience during a psychedelic journey, someone with pre-existing mental health concerns, or someone who does not have or may not want any connection to a community of other people who use psychedelics together.

Furthermore, not everyone is right for the PHRE group or able to attend, as it is bound by the realities of time, space, and cost. To this end, we at the PECCP are actively working to build our network of clinicians who can offer similar services, either individually or in groups. Our training program is gearing up to offer more instruction in psychedelic harm reduction and integration for clinicians, and, in the near future, will provide supervision as well as didactic sessions. We envision this group as one of many similar ones, and group psychotherapy as one of many possible options for psychedelic integration.

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Note:

This article is based on a talk given by the author at the Midwest Psychedelic Psychotherapy Symposium, Deforest, WI, April 28, 2018.