Psychedelic somatic interactive psychotherapy

1. Introduction

Version followed: Psychedelic Somatic Interactional Psychotherapy (PSIP) as Saj Razvi and the Psychedelic Somatic Institute (PSI) describe it on their own site (Razvi's articles from 2020 to 2024, the FAQ, the "Is PSI training right for me?" page and the Introduction to PSIP training page), plus the session frame of the one published PSIP case report (Ragnhildstveit et al., 2023, cannabis-assisted, Utah). Checked in October 2026 against PSI's FAQ, two training pages and the full case report for the founding paper, training structure, touch policy, exclusion criteria and legal frame (results in 1, 4.1, 4.21 and Sources). The founding description is not publicly available: the case report cites it as a journal article (Razvi & Elfrink, 2020, "The PSIP model: an introduction to a novel method of therapy", J Psychedelic Psychother 2:3), PSI's site lists it as the "PSIP White Paper" without a public copy, and a 2021 secondary paper cites it only for PSIP's mix of directive and non-directive work in the medicine phase [uncertain]. PSI's training lists the PSIP protocol, safety and contraindications, resourcing, trauma memory systems, the autonomic nervous system, and regression and traumatic transference as theory topics, but teaches their content only in training. So the in-session method below is reconstructed from public writing. [source: Ragnhildstveit et al. 2023; PSI pages; Whitfield 2021] [uncertain]

Name and authorship. Some listings call it "psychedelic somatic interactive psychotherapy". Its developers call it Psychedelic Somatic Interactional Psychotherapy (PSIP): PSI's FAQ, its training pages and the 2023 case report all use "Interactional", and none uses "interactive". This guide keeps the "interactive" wording in its title for indexing only; the correct name is the developers'. Saj Razvi, LPC, is PSI's founder and Director of Education. A third-party listing dates PSI to 2008, and PSI's research page reports a 2008 pilot of a non-medicine version (Oshier-Andrews, Wolterstorff & Razvi). Steve Elfrink is Razvi's co-author on the 2020 founding paper and co-presented the approach with him in 2021; descriptions of him as a co-founder of PSIP are secondary [uncertain: secondary, unverified]. [source: psychedelicsomatic.org home, FAQ, research and article pages; PSI Introduction to PSIP page; Ragnhildstveit et al. 2023 reference list; Blossom PSI listing; Mind Medicine Australia 2021 webinar listing]

What it is. PSI calls PSIP "a body-based, relationally engaged, comprehensive trauma modality" for the altered state, aimed mainly at complex developmental and attachment trauma and dissociation. It is not a drug protocol. PSI says it works with any medicine that produces an altered state, and in US private practice it names doctor-recommended ketamine and cannabis. Most published PSI work uses cannabis. [source: PSI home; Ragnhildstveit et al. 2023]

How change happens, in PSIP's theory. PSI says that "the agent of transformation in PSIP is a bottom-up, self-correcting process" run by the autonomic nervous system. The process becomes available when the managing, conscious self quietens in the altered state. Dissociation is treated as a parasympathetic, opioid-mediated, involuntary defence that holds "the heart of a traumatic event". Razvi argues that psychedelics alone do not resolve it, so the therapist has to engage it actively and relationally. Because "human relational wounding requires human relational healing", PSIP sees the relationship and the transference that arises in the altered state as the main medium of change, not insight or later narrative integration. [source: PSI home; Razvi 2020/2024 dissociation article; Razvi 2024 sitter-model article]

Legal and regulatory frame. In the published case, the client held a medical cannabis card issued by the Utah Department of Health under the Utah Medical Cannabis Act (House Bill 3001). The authors name the legality of cannabis in Utah as one reason she sought this treatment. Sessions took place in a private office, and the authors state that ethical review was not required under local rules. [source: Ragnhildstveit et al. 2023] PSI calls PSIP a "non-medicine specific modality" and markets it as "fully legal" psychedelic therapy. It calls cannabis "the most easily accessible, legal, and inexpensive psychedelic" for most clients, describes training sessions that use ketamine with oxytocin, and mentions an Amsterdam practice that began with cannabis-assisted sessions before psilocybin. PSI states that it does not "provide, prescribe, source, administer, direct, or manage" medicine in its trainings. [source: PSI Introduction to PSIP page; PSI FAQ; "Is PSI training right for me?"] These are PSI's own claims, and legality depends on jurisdiction. [uncertain]: in the US, cannabis was a Schedule I substance under the federal Controlled Substances Act at the case report's date, and a federal rescheduling process has been under way since 2024 whose current outcome is unconfirmed. State medical and adult-use laws vary, and a state medical card does not change federal status. Ketamine is a Schedule III prescription medicine, and its psychiatric use (other than esketamine) is off-label and must be prescribed and supervised by a licensed prescriber. Psilocybin is federally Schedule I, with state-regulated programmes in Oregon and Colorado. In the Netherlands, cannabis is sold under a tolerance policy and psilocybin truffles are sold legally. Rules in the UK, the EU (country by country) and Australia differ; Australia has allowed authorised psychiatrists to prescribe psilocybin and MDMA for specific indications since 2023. No recognised regulatory pathway is confirmed for therapist-present cannabis-assisted psychotherapy. PSIP is a proprietary training model with no external accreditation (PSI's NBCC continuing-education credits were discontinued). [source: Blossom PSI listing] The psychotherapist does not supply, prescribe or administer substances. Check your licensing board, malpractice insurer and local law before offering any medicine-assisted work. [synthesis]

2. Framework

PSIP has no published phase manual. The frame below combines the published case protocol with PSI's descriptions. [source: Ragnhildstveit et al. 2023; PSI pages] [uncertain]

Formats on record

Non-medicine PSIP. The 2008 pilot used 12 one-hour weekly sessions with 14 adults. The therapists were supervised psychology trainees. [source: PSI research page]
Medicine-assisted PSIP (published case: dissociative-subtype PTSD after non-response to CBT, EMDR, IFS and medication). It ran as a series of about 2-hour medicine-assisted sessions (ten in that case), each followed by a roughly 1-hour integration session. All sessions were video-recorded for ethics, safety and integration. [source: Ragnhildstveit et al. 2023]

Phases of the treatment course

Assessment and selection. Diagnostic interview and dissociation measurement. The case used the SCID-5 and the Multidimensional Inventory of Dissociation; items are not reproduced here. The case report also took a treatment history. It does not describe medical clearance, which is added here as the prescriber's responsibility [synthesis]. Goal: confirm a trauma or dissociation formulation and rule out contraindications (see 4.1). Move on when: the client is eligible, medically cleared and has given informed consent. [source: Ragnhildstveit et al. 2023]
Preparation. Psychoeducation about dissociation, the treatment course and its risks. Grounding and self-regulation skills. A clear, positive motive for treatment. Move on when: the client can use at least one grounding skill and can explain the plan, the risks and how to stop a session. [source: Ragnhildstveit et al. 2023; stop rule is synthesis]
Medicine-assisted PSIP sessions, each with four parts:
- Surfacing (about 10–15 min): thoughts, emotions and insights since the last session (skipped in session one).
- Resourcing (about 10–15 min): therapist-guided calming.
- PSIP work in the altered state: the bulk of the session.
- Closing (about 10–15 min): re-resourcing to the present, then a risk assessment.
[source: Ragnhildstveit et al. 2023]
Integration between sessions. A next-day phone check-in. The client reviews the session video and keeps a journal. A sober integration session follows; in the case it was CBT-based and used an "accept, connect, embody" (ACE) frame. PSI calls integration "very useful and stabilizing" but secondary, because it holds that the main shift happens during the session. [source: Ragnhildstveit et al. 2023; Razvi 2024]
Ending and follow-up. The case did qualitative follow-ups at 8, 16 and 24 months. End when: goals are met, dissociative symptoms have stabilised and the client functions day to day. Razvi warns that deeper material can surface weeks or months after earlier sessions, so leave the door open for return. [source: Ragnhildstveit et al. 2023; Razvi 2020/2024]

Criteria for continuing or pausing [synthesis]: continue when the client stabilises after each session (sleep, safety, daily functioning back to baseline within days) and the integration work is digesting the material. Pause the medicine sessions and go back to sober stabilisation if any of these appear: new or worse self-harm or suicidality, dissociative symptoms persisting between sessions (see PISD in 5), psychotic or manic features, or loss of function.

3. Guiding principles

[source: Razvi 2024 sitter-model article; Razvi 2020/2024 dissociation and MDMA articles; PSI home unless marked]

Bottom-up over top-down. The work aims at autonomic, non-declarative processes rather than insight. In practice: follow sensation, impulse and state over story, and do not chase interpretation.
Trust the self-correcting process. The body is held to have an innate correcting process. In practice: create the conditions and track. Don't manufacture an outcome, and let a process run until it completes or settles.
Active, interactional therapist, not sitter. The therapist is "an active participant in the client's psychedelic consciousness", unlike a non-directive sitter. In practice: stay in continuous contact and intervene when defences loop.
Relational tether. The therapist keeps some relational link even when the client goes into states of isolation, and the client reports inner experience aloud. In practice: agree beforehand that the client will narrate, and check in regularly.
Hyper-focus on dissociation. Dissociation is where the trauma is held, not a state to move away from. In practice: unlike standard resourcing approaches, step toward numbness, blankness and sleepiness within the client's tolerance, rather than moving away from it.
Non-response is an access point. "The seeming non-response is the access point to go deeper." In practice: treat "I feel nothing" as material, not as failure.
Do not feed the puppet show. Interesting imagery can keep dissociation in place. In practice: check whether content deepens felt experience. If it just loops, return to the body.
Directive engagement with defences. Defences persist in the altered state, and clients can loop in them for hours. In practice: name and work with management strategies rather than waiting.
Transference is the medium. Historical roles get projected onto the therapist, including negative ones. In practice: let yourself be seen as critical or distant without defending, and work with it.
Therapist self-work. Allowing negative transference without defensiveness "will take years of personal work and training". In practice: get supervision and personal process, and do not practise PSIP without training and supervision.
Human relational healing. Relational wounds are held to need relational repair. In practice: the quality of the relationship is part of the intervention, not a backdrop.
Safety and pacing [synthesis, informed by Elfrink & Bergin 2025]. Defences that dissolve faster than the person can integrate can cause harm. In practice: titrate, keep within tolerance, and stabilise before going deeper.

4. Intervention inventory

This inventory covers the procedures named in the sources cited. The step-by-step detail inside the altered-state interventions (4.7–4.16) is reconstructed from Razvi's public articles and the case report, because PSI teaches its protocol only in training (its FAQ lists the theory topics but not their content). Treat the step order as [synthesis] unless a step is cited. All example language is illustrative and written for this guide, not PSI's. Nothing here covers substance amounts, routes or timing: those are the prescriber's responsibility.

4.1 Eligibility and safety screening

Purpose / when: before any medicine-assisted work, to confirm the formulation and exclude people at high risk. [source: Ragnhildstveit et al. 2023 for SCID-5 and MID; Elfrink & Bergin 2025 for trauma-informed screening]
Steps:
1. Take a full trauma, attachment and treatment history, including past psychedelic or cannabis experiences and how they went.
2. Give a structured diagnostic interview (the case used the SCID-5) and a dissociation measure (the case used the MID). Note the dissociative subtype and any signs of a dissociative identity disorder (DID) or other specified dissociative disorder (OSDD) presentation.
3. Screen for psychosis, bipolar disorder, current suicidality and self-harm, substance use disorder (including cannabis use disorder) and pregnancy. Ask about cardiovascular and other medical conditions, and refer all medical screening and clearance to the prescribing physician. [synthesis: no published PSIP exclusion criteria; see the note below this list]
4. Assess stability: housing, support people, ability to get home safely and someone to contact after a session. [synthesis]
5. Decide jointly whether to start with sober (non-medicine) PSIP-style work or stabilisation first. [synthesis]
Example language (illustrative): "Before we consider medicine sessions, I need a full picture, including the parts of you that switch off or go numb. That's often exactly where this work goes."
Watch for: high dissociation scores combined with weak current stabilisation. These are the clients Elfrink & Bergin flag as at risk of destabilisation. Proceed slowly or not at all. [source: Elfrink & Bergin 2025; synthesis]

Published exclusion criteria (checked October 2026). No public PSIP source publishes client exclusion criteria. PSI lists "safety & contraindications" only as a topic taught in its training, and states that "PSIP is not appropriate for every client". Its FAQ and training pages give entry requirements for practitioners (graduate-level training or equivalent certification, licensure or certification, two years of mental-health practice), not criteria for clients. The 2023 case report describes intake with the SCID-5 and MID, but no formal inclusion or exclusion criteria and no medical clearance. The screening list above is therefore general psychedelic-therapy caution, not PSIP's protocol. [source: PSI FAQ; Introduction to PSIP page; "Is PSI training right for me?"; Ragnhildstveit et al. 2023] [synthesis for the screening list]

4.2 Informed consent

Purpose / when: at preparation, and revisited before each medicine session. [source: Ragnhildstveit et al. 2023 for written consent and video recording; the rest is synthesis]
Steps:
1. Explain what PSIP is: an active, directive, interactional approach, not a sitter model. Explain that the therapist will engage the client during the session and may bring their attention back to numbness or boredom.
2. Explain the expected experiences: strong body sensations, involuntary movement, temperature changes, emotional discharge, negative feelings toward the therapist (transference), and material that may surface weeks later.
3. Explain the risks: destabilisation and lasting dissociative symptoms (see PISD in 5), the legal status of the medicine, and that the evidence rests on one case report and an uncontrolled pilot.
4. Agree on video recording, its purpose, storage and deletion, in writing.
5. Agree on a stop signal and the client's right to end a session at any point. Agree on a touch policy in advance (4.21).
6. Record consent in writing, in a sober state. No new consents are obtained during the altered state.
Example language (illustrative): "If at any point you want to stop, say 'stop' and we stop, whatever is happening. You can change your mind about anything we've agreed today."
Watch for: a client agreeing to everything quickly or wanting to skip ahead. That can be fawning or a dissociative pattern. Slow down and check understanding.

4.3 Preparation: psychoeducation and grounding skills

Purpose / when: the preparation phase, to build a map and the skills to come back to the present. [source: Ragnhildstveit et al. 2023]
Steps:
1. Teach a simple model of trauma responses: active defences, then dissociation as an involuntary parasympathetic "shutdown". Present this as PSIP's model, not established fact. [source: Razvi 2020/2024]
2. Teach and practise grounding: orienting to the room, feeling the feet and the seat, slow breathing. [source: Ragnhildstveit et al. 2023 (named generally); specific skills are synthesis]
3. Describe what a session involves and the role of narration (4.8).
Example language (illustrative): "Numbness isn't you failing. In this model it's an automatic protective response. We'll learn to notice it together."
Watch for: whether the client can actually use a grounding skill under mild stress in session. If they can't, delay the medicine sessions.

4.4 Establishing a clear, positive motive

Purpose / when: preparation, so the client's "why" anchors hard sessions. [source: Ragnhildstveit et al. 2023]
Steps: help the client put into words what they want to move toward (for example, leaving the house, being present with their children), write it down, and revisit it at Surfacing. [steps are synthesis]
Example language (illustrative): "When this gets hard, what do you want to remember you're doing it for?"
Watch for: goals that are only about getting rid of feelings, or that are framed for someone else. Refine them into goals the client owns.

4.5 Surfacing (session opening)

Purpose / when: at the start of every medicine session except the first, to bring forward what has emerged since the last session. [source: Ragnhildstveit et al. 2023]
Steps: ask about thoughts, emotions, dreams, body changes and insights since the last session. Check safety and sleep. Note any themes that may come back in the session. [detail is synthesis]
Example language (illustrative): "What's been moving since last time: in your body, your sleep, your relationships?"
Watch for: new instability. If present, consider a sober session instead (see 2, continue/pause criteria).

4.6 Resourcing (pre-session calming)

Purpose / when: after Surfacing and before the altered-state work, to settle the nervous system. [source: Ragnhildstveit et al. 2023]
Steps: guide slow deep breathing, recall of a positive memory, and imaginative calming such as a safe-place image, for about 10–15 minutes. [source: Ragnhildstveit et al. 2023]
Example language (illustrative): "Let's take a few slow breaths. Bring to mind a time you felt even a little safe, and notice where your body registers it."
Watch for: resourcing that triggers distress, which is common in clients with no early experience of safety. Switch to external orienting instead. [synthesis]
Note: PSI also says it does not resource clients away from dissociation during the work itself (see 4.11). Resourcing here frames the session; it does not replace the work. [source: PSI home]

4.7 Continuous multi-channel tracking

Purpose / when: throughout the altered-state work. This is the therapist's core activity in PSIP. [source: Razvi 2024 sitter-model article]
Steps: keep watching six things Razvi names (the source lists them; the scanning order is synthesis):
1. The client's resource level.
2. Their autonomic state: arousal up, or shutdown and collapse.
3. Signs of dissociation: flatness, sleepiness, blankness, "feeling sober".
4. Their capacity to allow relationship, or to allow solutions.
5. Transference toward you.
6. Conscious management strategies the client uses to avoid material.
Razvi also refers to "biological reference points" that predict the nervous system's direction. Their content is taught in training and is not published. [uncertain]
Example language (illustrative): "What's happening in your body right now?" / "Something just shifted in your breathing. What do you notice?"
Watch for: your own drift into boredom or dissociation. Razvi notes therapists must not go defensive or dissociative themselves.

4.8 Relational tether and narration

Purpose / when: all through the session, so the client is not alone in isolated states. [source: Razvi 2024]
Steps:
1. Agree in preparation that the client will describe what they experience, briefly and in present tense.
2. When they go silent, check in briefly.
3. Reflect back in a few words, without interpreting.
[steps are synthesis]
Example language (illustrative): "I'm right here. Tell me what's there, even if it's nothing."
Watch for: long silences with flat affect, which suggest dissociation rather than absorption. Bring them back to narration (4.11).

4.9 Selective inhibition

Purpose / when: in the altered state, to keep automatic coping (fidgeting, distraction, moving away) from discharging or blocking a defensive state, so the state can be felt and processed. The case report describes the client being guided to hold back voluntary movement and coping strategies while fully acknowledging the urges. This brought on hypo- and hyperarousal (depersonalisation, agitation), which was then processed. [source: Ragnhildstveit et al. 2023]
Steps (synthesis around the cited core):
1. Notice the coping move: shifting position, opening the eyes to escape, changing the subject, joking.
2. Name it without judgement.
3. Invite the client to notice the urge fully but not act on it yet.
4. Keep them company in the rising state.
5. Stop inhibiting if the agreed stop signal is given or arousal goes beyond tolerance (see 5).
Example language (illustrative): "There's an urge to move. Can you let yourself feel that urge completely, just for now, without doing it?"
Watch for: genuine distress versus processing. Processing tends to move: a wave builds and then settles. Overwhelm tends to escalate or fragment (see 5). Never use inhibition to override a client's no.

4.10 Staying with sensation until it subsides

Purpose / when: once a strong sensation, tremor, heat or emotional wave arises, to let the autonomic process complete. [source: Ragnhildstveit et al. 2023]
Steps:
1. Ask the client to stay with the sensation and describe its quality and location.
2. Avoid interpreting or adding content.
3. Wait until it diminishes on its own.
4. Check what is there afterwards.
[steps 1, 3 and 4 detail are synthesis]
Example language (illustrative): "Let it do what it's doing. You don't have to understand it. Just tell me what it's like now."
Watch for: the case reported muscle contractions, raised body temperature and physical discomfort that resolved fully. Any concerning physical sign is for medical staff to assess (see 5).

4.11 Stepping toward dissociation: holding a somatic container for blankness

Purpose / when: when the client reports feeling nothing, sober, bored or sleepy, or that "it isn't working". [source: PSI home; Razvi 2020/2024 dissociation and MDMA articles]
Steps:
1. Don't move to more evocative material, and don't resource the client away from the state.
2. Bring the direct experience of blankness or sleepiness into focus as the object of attention.
3. Stay with it together, sometimes for half an hour or longer, until it "will crack" and feeling or memory emerges.
4. Keep the relational tether (4.8) so the client is not alone in numbness.
[source: Razvi articles for steps 1–3; step 4 is from Razvi 2024]
Example language (illustrative): "Let's not look for anything else. What is this 'nothing' like? Where is it in your body?"
Watch for: sleep. Razvi notes that unaccompanied clients may just fall asleep. Also watch for stories layered on top ("nothing ever works for me"); treat the story as defence (4.14). Contrast: EMDR protocols stop when a client dissociates, while PSIP works inside it. Apply this only within tolerance (see PISD in 5). [source: Razvi MDMA article]

4.12 Checking imagery against felt sense

Purpose / when: when visual or narrative content appears, to tell whether it leads into felt experience. [source: Razvi dissociation article]
Steps:
1. Ask whether the client can feel the image.
2. If yes, move attention to the felt sense, which Razvi says often leads to an autonomic process.
3. If no, note it and keep observing (see 4.13).
Example language (illustrative): "You're seeing the house. Can you feel anything as you see it? Where?"
Watch for: a shift from describing to experiencing. That shows in a change of voice, breath or body.

4.13 Interrupting looping and not chasing evocative content

Purpose / when: when content keeps changing without deepening, which Razvi calls "a distractive puppet show" that keeps dissociation in place. [source: Razvi MDMA article]
Steps:
1. Notice the repetition: imagery that morphs endlessly, or recurring themes with no felt change.
2. Name it gently.
3. Return attention to the body or to the blankness underneath (4.11).
4. Hold back your own wish to give the client something stimulating.
Example language (illustrative): "This keeps changing, and I notice you're not really feeling any of it. Let's come back underneath it, to your body."
Watch for: the client feeling criticised. Frame looping as protection, not failure.

4.14 Directive engagement with defences and management strategies

Purpose / when: when conscious strategies such as intellectualising, pleasing the therapist, humour, planning or self-criticism hold the client in a loop. Razvi says clients can loop for hours without directive engagement. [source: Razvi 2024]
Steps (synthesis):
1. Identify the strategy you're tracking (4.7 channel 6).
2. Reflect it as a protective move.
3. Ask what it might be protecting against, or invite the client to set it aside briefly and notice what is underneath.
4. If the defence holds, respect it and work with the defence itself rather than forcing through. This is consistent with Elfrink's emphasis on working with protective parts rather than breaking through. [source: Psychedelic Support 2026]
Example language (illustrative): "You're explaining it really well. What happens if we stop explaining for a moment and just feel?"
Watch for: compliance rather than real opening. A sudden "breakthrough" with no body change may be pleasing you.

4.15 Working with transference in the altered state

Purpose / when: when the client experiences the therapist as a historical figure (critical, distant, angry, abandoning, or idealised). PSIP treats this as central. [source: Razvi 2024]
Steps (synthesis around cited core):
1. Notice the projection.
2. Allow it without defending or correcting.
3. Invite the client to feel what happens in their body as they see you this way.
4. Stay steady and present, so the old relational pattern meets a different response.
5. In the sober integration session, help the client separate past from present.
Example language (illustrative): "Right now I seem cold to you. That's OK. Stay with what happens inside when I'm like that."
Watch for: Razvi says that if negative transference can't come out in the room, it may "express elsewhere", most often in partnerships. Also watch your own countertransference, and take it to supervision.

4.15a Sustained eye contact

Purpose / when: PSI names "the intervention of sustained eye contact" in sessions at its Apprentice trainings, where it is used to bring relational patterns to the surface (described in a podcast summary on PSI's site). It serves the relational, transference-focused stance of 4.15. [source: PSI "Is PSI training right for me?" page] How PSI teaches it is not published. [uncertain]
Steps [synthesis]: agree on it in a sober preparation session as an option the client may decline. In session, offer it and never require it. Keep a comfortable distance, and let the client set how long it lasts and look away at any time. Track autonomic state (4.7) and any transference that arises, and ask the client to narrate what happens in the body (4.8).
Example language (illustrative): "Would you be willing to look at me for a little while? You can look away whenever you need to."
Watch for: shame, freezing or fawning compliance, sharp rises in arousal, and the client experiencing you as a historical figure (material for 4.15). Stop if the client becomes overwhelmed (see 5).

4.16 Supporting traumatic discharge

Purpose / when: when involuntary shaking, contractions, heat, crying or catharsis arise. The case report describes "traumatic discharge", sometimes ending in psychocatharsis. [source: Ragnhildstveit et al. 2023]
Steps:
1. Keep the space physically safe (cushions, space to move).
2. Narrate calmly that what's happening is permitted.
3. Don't amplify it or push for catharsis.
4. Track for completion: breath slows and settles.
5. Then check in about what is there now.
[steps are synthesis; Psychedelic Support 2026 reports that PSIP favours bottom-up processing over cathartic release]
Example language (illustrative): "Your body knows how to do this. I'm here. Let it move through."
Watch for: discharge that keeps escalating without any settling phase, or the client losing contact with you. Move to stabilisation (see 5).

4.17 Closing: re-resourcing and risk assessment

Purpose / when: the last 10–15 minutes of every medicine session. [source: Ragnhildstveit et al. 2023]
Steps:
1. Guide orientation back to the room and the present.
2. Repeat calming resources.
3. Do a risk assessment: suicidality, self-harm urges and dissociation level. [source: case report]
4. Confirm that a safe person will take the client home, and that medical staff have cleared their physical state. [synthesis]
5. Remind them of the next-day call.
Example language (illustrative): "Let's come back to the room together. Name three things you can see. How are you feeling about being on your own tonight?"
Watch for: a client who seems fine but is flat or vague. Ask directly about safety, and don't release them alone.

4.18 Video recording and client review

Purpose / when: every session in the case, for ethics, safety and integration. Between sessions the client reviewed the recording. [source: Ragnhildstveit et al. 2023]
Steps:
1. Get written consent (4.2).
2. Store the recordings securely.
3. Agree whether the client will review them alone or in session.
4. Advise them to stop reviewing if it destabilises them. [steps 2–4 are synthesis]
Example language (illustrative): "Watching yourself can be powerful and also hard. If it's too much, stop, and we'll look at it together."
Watch for: shame or re-traumatisation when watching. Recording also protects the client and the therapist in altered-state work, especially if any touch has been agreed (4.21) [synthesis].

4.19 Next-day check-in

Purpose / when: the day after each medicine session. [source: Ragnhildstveit et al. 2023]
Steps: a brief call covering sleep, mood, safety, physical state and any emerging material. Bring the integration session forward if needed. [detail is synthesis]
Example language (illustrative): "How did you sleep, and what's been coming up since yesterday?"
Watch for: new dissociative symptoms, intrusive memories or suicidal thoughts. Act on your risk protocol.

4.20 Integration session

Purpose / when: a sober session after each medicine session. In the case it was CBT-based, used an "accept, connect, embody" (ACE) frame, and was supported by journaling. [source: Ragnhildstveit et al. 2023] PSI treats integration as stabilising but secondary, and does not require insight or a recovered narrative. [source: Razvi 2024]
Steps (synthesis within the ACE frame named by the case):
1. Review what happened and how the client is now.
2. Accept: acknowledge what was felt without judging it.
3. Connect: link it to present life and relationships, including transference that came up.
4. Embody: choose a small, body-based or behavioural step for the coming days.
5. Plan the next session.
Example language (illustrative): "You don't need to make sense of all of it. What feels different, even slightly, in your body or your day?"
Watch for: pressure to build a story. Razvi says narrative may not come, and that's fine.

4.21 Touch: policy and consent [synthesis: no published PSI touch policy found]

No public PSIP source describes touch. PSI's FAQ, the "Is PSI training right for me?" page and the Introduction to PSIP training page contain no touch policy, touch-consent wording or touch-ethics statement, and the 2023 case report does not mention touch or physical contact. The only relational-contact intervention PSI names is sustained eye contact (4.15a). PSI's site links a Concern & Ethics Reporting Form; no PSI code of conduct is published [uncertain]. No touch technique is attributed to PSIP here. The default is no touch. If your setting permits supportive touch at all, use only the strict framework below. It follows published research on touch ethics in psychedelic-assisted therapy [source: McHerron et al. 2025]; the rest is [synthesis].

Purpose / when: only non-sexual, supportive contact, for example a hand to hold or a hand on the shoulder for grounding, and only where agreed in advance in a sober session. Never touch to provoke or intensify material. Many clinicians should use no touch at all. [synthesis]
Steps:
1. Discuss touch in a sober preparation session, not only on a form. Explain the purpose, risks and benefits of each kind of contact, and offer non-touch alternatives. Agree in writing on the specific type and location of any contact, or on no touch; who may touch; whether the client must be the one to initiate; and how the client will say no. Practise the "no" signal (words or a hand signal) before the medicine session. [source: McHerron et al. 2025; written agreement is synthesis]
2. Consent is ongoing. Ask before each contact, even within the agreement, and check again during it, using open questions and agreed signals because speech may be impaired. The client can decline or withdraw consent at any time, including under the medicine's effects; stop at once when they do. "No" and the stop signal always win. [source: McHerron et al. 2025]
3. Never expand the agreement during the altered state. New requests are noted and discussed sober. [source: McHerron et al. 2025]
4. Touch of any sexual nature is never permitted under any circumstances. [source: McHerron et al. 2025, which calls sexual or hostile touch "unambiguously unethical"]
5. Record the agreement and every contact in the notes, video-record (4.18), and wherever possible have a second staff member present. Give the client a named person outside the therapy pair to whom they can raise any concern about touch. [source: McHerron et al. 2025 for a standard recording protocol, video review and an outside contact; second staff member is synthesis]
6. Review touch at each integration session.
Example language (illustrative): "We agreed I could offer my hand if you want it. Would you like that now? Yes or no is completely fine."
Watch for: freeze or fawn responses: compliance is not consent. In altered states, clients with developmental trauma may be unable to refuse. Report any concern through your ethics body. PSI provides a Concern & Ethics Reporting Form. [source: PSI site for the form]

4.22 Harm reduction and integration for clients using outside clinics or on their own [synthesis]

This is the general clinician's harm-reduction and integration role; it is not a PSIP procedure.

Purpose / when: a client in ordinary therapy is using cannabis, ketamine or psychedelics elsewhere, or plans to.
Steps:
1. Assess without judgement: what, why, in what setting, with whom, and the history of effects.
2. Screen for warning signs (psychosis or bipolar history, dissociative disorder, suicidality, problematic use).
3. Give general risk education: cannabis can provoke anxiety, paranoia or psychotic symptoms in vulnerable people. Interactions with prescribed medicines must be checked with a physician or pharmacist.
4. Make a safety plan: a sober support person, no driving, crisis contacts.
5. Refer to legal, medically supervised services where they exist.
6. Offer integration sessions afterwards.
You do not facilitate, supply or guide illegal use.
Example language (illustrative): "I'm not going to help you arrange this, but I do want you safe, and I'm here to help you make sense of whatever comes up."
Watch for: symptoms of iatrogenic dissociation after use (see 5).

4.23 Non-medicine PSIP

Purpose / when: PSI piloted a non-medicine version in 2008 (12 one-hour sessions, delivered by supervised graduate trainees). It suits clients who are ineligible for medicine work, or as a stabilisation stage. [source: PSI research page]
Steps: apply tracking (4.7), the relational tether (4.8), felt-sense work (4.12) and transference work (4.15) in ordinary sober sessions, at a gentler intensity. [application is synthesis: the pilot's protocol was not published]
Example language (illustrative): "Let's slow right down and just notice what your body does when you talk about her."
Watch for: the same signs of working and overwhelm as in medicine sessions, though usually lower in intensity.

5. Handling problems

"Nothing is happening" / the client feels sober, bored or sleepy. In PSIP this is expected and is the access point, not a failure. Use 4.11: focus on the blankness, stay with it, and keep the client from falling asleep through narration. Explain beforehand that it may take a long stretch before it shifts. [source: Razvi MDMA and dissociation articles]

Looping or endless imagery. Use 4.12 and 4.13: check imagery against felt sense, name the loop, and return to the body. Resist the urge to provide stimulation. [source: Razvi articles]

Defensive meaning-making ("nothing ever works for me"). Treat the story as a layer on top of the experience. Acknowledge it, then come back to what is directly felt. [source: Razvi MDMA article]

Resistance and defences. Engage directively (4.14), but treat defences as protective parts to work with, not walls to break through. Forcing through is the route to destabilisation. [source: Razvi 2024; Psychedelic Support 2026 on Elfrink]

Overwhelm beyond the window of tolerance [synthesis]. Signs: escalating panic without any settling wave, loss of contact with you, fragmentation, intense terror, or self-harm urges. Responses, in order:

Stop any inhibition or deepening intervention.
Orient the client to the room and your voice.
Use agreed grounding skills (4.3).
Slow your speech, and sit within view.
Bring in medical staff for physical concerns.
Do not end the session until the client is oriented and safe.
Make a safety plan and arrange an early follow-up.

Note the tension: PSIP deliberately works toward dissociative states (the case report says these were "deliberately evoked"). Applying that stance within each client's tolerance is a judgement made in training and supervision; how PSI teaches it is not published. [uncertain]

Psychedelic iatrogenic structural dissociation (PISD) [source: Elfrink & Bergin 2025, a hypothesis paper; Psychedelic Support 2026]. Elfrink and Bergin propose that defences can dissolve faster than a person can integrate, leading to fragmentation along "apparently normal" and "emotional" part lines. Reported signs include emotional dysregulation, identity disturbance, derealisation, perceptual disturbance, flashbacks and resurfaced trauma. Response: pause medicine sessions. Return to phase-oriented stabilisation (safety, self-injury and suicidality, dissociative phobia, integrative capacity) before any memory work, using body-focused methods and social support. More intensity does not mean more healing.

Acute physical reactions. The case reported muscle contractions, heat and discomfort that resolved, and the authors report that no adverse events were clinically observed or self-reported. Assessing and managing these is the medical team's job, not the therapist's. Agree an escalation pathway in advance. [source: Ragnhildstveit et al. 2023; escalation is synthesis]

Negative transference and ruptures. Inside the session, allow and work with the transference (4.15). Afterwards, in the sober session, repair explicitly: name what happened, acknowledge your part, and separate past from present. If a rupture looks like real misattunement by you rather than projection, own it. [source: Razvi 2024 for allowing transference; repair is synthesis]

Therapist defensiveness or dissociation. Razvi says practitioners need extensive personal work. Track your own state; a pull to explain, defend or reassure may be countertransference. Get supervision after intense sessions. [source: Razvi 2024; supervision is synthesis]

Material surfacing weeks or months later. Razvi frames this as deeper layers becoming available, not as a sign earlier sessions failed. Normalise it, keep the door open, and check stability. [source: Razvi MDMA article]

Non-adherence (missing integration sessions, not reviewing video, extra substance use between sessions) [synthesis]. Explore the function of the avoidance. Make integration a condition of continuing medicine sessions. Screen for problematic use and address it before continuing.

Suicidality and self-harm [synthesis, standard practice]. Assess at every closing (4.17) and next-day call. Use a written safety plan with lethal-means counselling (safe storage, removal). Pause medicine work if risk rises. Arrange crisis care if needed.

Psychotic or manic symptoms after a session [synthesis]. Stop medicine work, arrange urgent psychiatric assessment, and review eligibility.

Boundary, power and consent risks [synthesis]. Altered states, an active directive therapist, regression and possible touch together raise the risk of exploitation and of confused consent. Safeguards: written agreements made sober, video recording, a second staff member, a no-sexual-contact rule with no exceptions, external supervision and a clear complaints route (PSI's ethics form, your licensing board). [source: PSI site for the form]

Legal and scope problems [synthesis]. Do not give medicine-assisted sessions where your jurisdiction or licence does not permit it. Prescribing and medical monitoring stay with licensed medical staff. Carry appropriate insurance.

Limits of the evidence base. The model rests on one published case report and an unpublished, uncontrolled pilot. Tell clients this plainly during consent. [source: PSI research page; Ragnhildstveit et al. 2023]

Sources

Web sources

Further web sources (checked October 2026):

Cited, no public copy [uncertain]

Razvi, S., & Elfrink, S. (2020). The PSIP model: an introduction to a novel method of therapy: psychedelic somatic interactional psychotherapy. J Psychedelic Psychother 2:3 (as cited by Ragnhildstveit et al. 2023; listed on PSI's site as the "PSIP White Paper").
PSI Concern & Ethics Reporting Form (linked from PSI's site; its content is not summarised here).
Nutt, D. (2019), cited by Razvi for the definition of the sitter model.

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