Psychedelic integration therapy

1. Introduction

Version followed: the Psychedelic Harm Reduction and Integration (PHRI) model of Gorman, Nielson, Molinar, Cassidy & Sabbagh (2021) for clinical stance and harm-reduction tasks; the synthesized six-facet integration model of Bathje, Majeski & Kudowor (2022) for structuring integration work; the legal and ethical boundaries of Pilecki et al. (2021); and, for meaning-making and behaviour change, the ACE (Accept, Connect, Embody) model of Watts & Luoma (2020). Where these differ, the differences are named below.

What it is. Psychedelic integration therapy is not one manualised therapy. It is a family of frameworks for psychotherapy that helps a person make sense of a psychedelic or other non-ordinary experience and carry its lessons into daily life. Bathje et al. (2022) reviewed 24 definitions and ten published models (all from 2017 onward). They define integration as revisiting and making sense of the experience, then gradually bringing its lessons into everyday life, aiming for balance and wholeness within the person and in their lifestyle, relationships and relation to the natural world. They quote Bourzat & Hunter (2019): "Integration is the process of bringing separate elements together into a whole". [source: Bathje et al. 2022]

Who it is for in a psychotherapy practice. PHRI is described as a "transtheoretical and transdiagnostic clinical approach" for patients who use, or are considering using, psychedelics in any context, including outside clinics. It combines harm-reduction psychotherapy with elements of psychedelic-assisted psychotherapy, and can be used as brief or ongoing therapy. The therapist never provides, gives or facilitates access to substances and does not attend dosing sessions. [source: Gorman et al. 2021 abstract; Blossom summary of Gorman et al. 2021; Blossom summary of Pilecki et al. 2021]

Core idea of change. Bathje et al. hold that psychedelics may not heal on their own. Instead they may surface what needs to be addressed. Without active integration, insights tend to fade, and difficult experiences can reinforce trauma or defences. PHRI treats psychedelics as non-specific amplifiers of material already present in the person. Change comes from working through that material in a safe alliance, then translating insights into valued behaviour over time. [source: Bathje et al. 2022; Blossom summary of Gorman et al. 2021]

Scope note: this guide gives no information about doses, sourcing, preparation of substances, routes or schedules of administration. The clinician's role for people who use outside regulated settings is harm reduction and integration support only.

2. Framework

Status of the evidence on structure. No source gives a fixed session count for integration therapy. PHRI is stated to work in brief or ongoing formats. Bathje et al. stress that integration is long-term, should not be rushed, and that action in the world comes after internalising the experience. The phases below combine the published models. The session numbers are my own planning suggestions. [source: Bathje et al. 2022; Gorman et al. 2021 abstract] [synthesis for session counts]

How the published models sequence the work [source: Bathje et al. 2022, describing each model]

Bourzat & Hunter (2019), Holistic Model for a Balanced Life: (1) returning from the experience by capturing its narrative; (2) understanding it by identifying themes and decoding content; (3) implementing practices across body, mind, spirit, community and natural environment; then sharing transformations with the world.
Watts & Luoma (2020), ACE model, integration stages as summarised by Bathje et al.: non-directive validation, then structured meaning-making, then directive goal-setting for behaviour change. The six psychological-flexibility processes are grouped into an Acceptance triad (defusion, present-moment focus, willingness) and a Connection triad (self-as-context, values, committed action). [source: Watts & Luoma 2020 abstract via ACBS]
Sloshower et al. (2020), ACT-based protocol for psilocybin therapy for depression: integration starts by eliciting the client's narrative, then moves to values, behavioural activation and mindfulness, with practices largely initiated by the therapist.
Gorman et al. (2021), PHRI: assessment, preparation/harm reduction where the person plans use, and integration after use, including work with difficult experiences.

Phase A. Intake and assessment (suggested 1 to 2 sessions) [synthesis for count]

Goal: understand the person, their relationship to psychedelics, risk factors and what they want from therapy.
Content: standard diagnostic assessment; psychedelic-specific history (planned or spontaneous experiences, motives, history of use, social and community ties, and the client's own definition of successful integration); safety screening; informed consent covering scope and legal boundaries. [source: Blossom summary of Gorman et al. 2021; Blossom summary of Pilecki et al. 2021]
Move on when: the client understands what the therapist will and will not do, there is a working formulation, and acute risk is addressed. [synthesis]

Phase B. Pre-experience harm reduction and preparation (only where a client has independently decided to have an experience, or is entering a legal programme or trial; suggested 1 to 3 sessions) [synthesis for count]

Goal: reduce risk and plan support for afterwards, while staying within legal limits.
Content: balanced education on risks, benefits, contraindications and the need for medical advice on interactions; reviewing legal alternatives such as clinical trials or legal ketamine treatment; set and setting, intentions and expectations; safety and re-entry planning; inventorying integration resources and planning time and space for integration; agreeing how to reach the therapist afterwards. [source: Blossom summaries of Gorman et al. 2021 and Pilecki et al. 2021; Bathje et al. 2022]
Legal note: Pilecki et al. flag preparation (helping plan an experience) as carrying more legal risk than integration. [source: Blossom summary of Pilecki et al. 2021]
Move on when: the client has had their experience (in whatever context), or decides not to. Therapy may continue as ordinary treatment. [synthesis]

Phase C. Early integration: returning and validating (suggested 1 to 3 sessions, ideally soon after the experience) [synthesis for count and timing]

Goal: help the person tell and hold the story without premature interpretation; stabilise if distressed.
Content: narrative capture, non-directive validation, experiential processing of what is still present in the body and emotions, and work with fear or disorientation. [source: Bathje et al. 2022 on Bourzat & Hunter, ACE and Sloshower; Blossom summary of Gorman et al. 2021]
Move on when: the client can describe the experience with tolerable arousal and is sleeping and functioning at baseline or better. [synthesis]

Phase D. Meaning-making (suggested 2 to 6 sessions) [synthesis for count]

Goal: identify themes, decode symbolic content, link the experience to the client's history and values, and revisit original intentions.
Content: theme identification, symbolic and dream work, values clarification, defusion from rigid interpretations, psychodynamic exploration. [source: Bathje et al. 2022]
Move on when: the client can name a few concrete lessons or values they want to act on, held with some flexibility rather than certainty. [synthesis]

Phase E. Embodiment and implementation (ongoing; brief check-ins can continue for months) [synthesis for duration]

Goal: turn insights into sustained practice and behaviour change, balanced across life domains.
Content: selecting integration practices across the six facets, committed action and goal-setting, behavioural activation, relational and community steps. [source: Bathje et al. 2022]
Ending: Bathje et al. note insights may keep unfolding over a lifetime. End formal therapy when practices are self-sustaining; offer return sessions. [source: Bathje et al. 2022] [synthesis for ending criteria]

Format. Individual sessions are the norm in PHRI. The practice lists in Bathje et al. include group therapy and sharing circles as integration options. Session length follows the clinician's usual practice. [source: Bathje et al. 2022] [synthesis for format detail]

Bathje et al. six-facet map (use it to assess balance and choose practices): mind/cognitive/emotional; bodily/somatic; spiritual/existential/ritual; natural world; relational/communal; lifestyle/action. An outer ring of six continuums classifies practices: conscious vs unconscious; internal vs external; creative vs receptive; active vs passive; outside the comfort zone vs gentle self-care; contemplative vs expressive. The aim is a balance across all facets and both ends of each continuum. [source: Bathje et al. 2022]

Legal and regulatory frame (as of the sources' dates, 2021 to 2024; check current law before practising)

General: psilocybin, LSD, DMT and MDMA remain controlled in most countries, with exceptions for research, certain religious uses or licensed settings. Ketamine is a current legal exception in clinical practice. [source: Blossom summary of Pilecki et al. 2021]
United States, federal: MDMA remains Schedule I. The FDA declined to approve MDMA for PTSD, citing insufficient evidence on long-term efficacy, risks and the psychotherapy protocol. [source: Loyola Inside Compliance blog, Nov 2024]
Oregon: Measure 109 (2020) created a regulated Psilocybin Services Program overseen by the Oregon Health Authority, with trained, licensed facilitators. Use outside that programme remains illegal. [source: Loyola blog 2024]
Colorado: Proposition 122 (2022) decriminalised personal use of several natural psychedelics (excluding peyote) and set up a path to regulated "healing centers". [source: Loyola blog 2024]
Australia: authorised psychiatrists can prescribe MDMA and psilocybin for specific indications since 2023. [uncertain: verify with the TGA]
Practice implication: integration of an experience that has already happened is the lowest-risk activity. Helping someone obtain substances, providing a venue, attending sessions or referring to underground guides is outside the role. [source: Blossom summary of Pilecki et al. 2021] Status may have changed by 2026. [uncertain]

3. Guiding principles

[source: Gorman et al. 2021 abstract and Blossom summary for PHRI principles; Pilecki et al. 2021 via Blossom summary for legal and ethical principles; Bathje et al. 2022 for integration principles]

Harm reduction, not abstinence. Meet the client's choices with "compassionate, destigmatizing acceptance of patients' choices" (Gorman et al. 2021). In practice, you neither encourage nor forbid use. You help the person lower risk and get value from what happens.
Respect autonomy, stay goal-oriented. The client defines what successful integration means. In practice, ask for their definition early and return to it.
Experiences are not inherently pathological. In practice, do not reflexively diagnose unusual or mystical content. Assess function and distress instead.
Alliance first. PHRI rests on a strong therapeutic alliance. In practice, repair any sense of judgment before doing technical work.
Curious, improvised inquiry. The stance is curious and dialogic, following the client's own experience. In practice, ask open questions about what happened before offering frameworks.
Non-directive, inner-directed trust. PHRI trusts the client's own capacity for meaningful insight. The Blossom summary says the paper calls this an "inner healing intelligence". In practice, let the client lead interpretation; offer, don't impose. [uncertain: wording reported via secondary summary]
Psychedelics amplify what is already there. In practice, explore experiences as windows on pre-existing material, history and relationships.
Track transference and countertransference. Psychedelics may loosen defences. In practice, watch for idealisation, dependency or fear directed at you, and for your own enthusiasm or scepticism.
Do not impose, do not avoid, spiritual meaning. Bathje et al. advise neither imposing spiritual interpretations nor avoiding spiritual topics. In practice, ask whether the client wants a spiritual focus.
Don't rush; internalise before acting. In practice, slow down big life decisions (job, relationship, relocation) until the experience has been digested.
Balance across facets and continua. In practice, notice if all integration is in one domain (e.g. only talking) and widen it.
Pace to resources. People with fewer resources may benefit from a gradual approach; those with many may need to slow down and reflect before acting. [source: Bathje et al. 2022]
Know your limits; collaborate and refer. In practice, keep a referral network for medical, psychiatric, somatic, spiritual and cultural support.
Never facilitate access or attend use. In practice, no sourcing advice, no venue, no sitting for illegal sessions, no referrals to underground guides. [source: Pilecki et al. 2021 via Blossom]
Clear boundaries in writing. In practice, state your scope in advertising and consent forms.
Competence and honesty about evidence. Train, seek peer consultation, and avoid overstating benefits. In practice, give balanced risk-benefit information.
Screen carefully and document. In practice, record assessment, education given and safety planning.
Cultural humility. Adapt screening for racial trauma and mistrust; be aware of cultural appropriation and access barriers. Bathje et al. also note harms of extractive psychedelic tourism to Indigenous communities. In practice, ask about cultural context and avoid treating Indigenous practices as techniques to borrow.
Attribute spiritual and traditional frameworks. When a client uses a tradition's concepts (e.g. spirits, energy, the soul), treat these as that tradition's theory and the client's meaning, not as clinical fact. [synthesis]
Examine your own motives. Pilecki et al. include reflection questions for clinicians on motivation, competence and risk tolerance. In practice, review these before offering the service. [source: Blossom summary of Pilecki et al. 2021]

4. Intervention inventory

Sourcing note: the content here for Gorman et al. (2021) and Pilecki et al. (2021) comes from the published abstract and from Blossom's structured summaries. Step-by-step instructions are mine, built around the elements those sources name, and are marked [synthesis]. All example wording is illustrative unless quoted.

A. Assessment and consent

4.1 Scope-and-boundaries informed consent

Purpose / when: first contact and first session; before any harm-reduction conversation. Pilecki et al. recommend stating boundaries clearly in advertising and consent forms. [source: Blossom summary of Pilecki et al. 2021]
Steps: [synthesis] (1) State what you offer: assessment, education about risks in general terms, safety planning, integration therapy. (2) State what you do not do: provide or help obtain substances, provide a place for use, attend or guide sessions, recommend underground guides. (3) Explain confidentiality and its limits under your jurisdiction's law, and how you document. (4) Explain that the evidence base for integration therapy itself is thin. (5) Invite questions and record consent.
Example language (illustrative): "I can help you think through risks and make sense of what happened afterwards. I can't help you get anything, and I won't be there during use. Does that fit what you're looking for?"
Watch for: clients hoping you will act as a guide or connector; hearing "no" as judgment. Working: the client can restate the boundaries and still wants to proceed.

4.2 Psychedelic-specific assessment interview

Purpose / when: intake, and whenever a new experience is reported. PHRI adds psychedelic-specific questions to standard assessment. [source: Blossom summary of Gorman et al. 2021]
Steps: (1) Complete your usual diagnostic assessment and differential diagnosis. (2) Ask whether experiences were planned or spontaneous. (3) Explore motives: recreation, healing, spirituality, growth. (4) Take a history of use and context, without asking for amounts unless clinically needed for medical referral. (5) Map social and community ties, including ceremonial or peer communities. (6) Ask the client how they would define successful integration. [source: Blossom summary of Gorman et al. 2021] (7) Note any persisting changes in perception, sleep, mood or functioning since the experience. [synthesis]
Example language (illustrative): "What drew you to this experience? Looking back, what would tell you it has been well integrated?"
Watch for: shame or guardedness about illegal use (slow down, restate confidentiality); signs of mania or psychosis that need psychiatric evaluation. Working: the client shares openly and offers their own goals.

4.3 Risk screening and medical referral

Purpose / when: before any planned experience, and after an experience with persisting symptoms. PHRI preparation includes education on contraindications and medication interactions; Pilecki et al. advise referring medication-interaction questions to prescribers. [source: Blossom summaries of Gorman et al. 2021 and Pilecki et al. 2021]
Steps: (1) Screen for personal and family psychiatric history, especially psychotic and bipolar disorders, current suicidality, recent major losses or crises, cardiovascular and other medical conditions, and current medications and supplements. [uncertain: trial exclusion criteria; these are commonly cited in the trial literature] (2) Do not advise on interactions yourself; refer the client to their prescriber or a physician. (3) Where the client is entering a legal programme or trial, encourage full disclosure to that programme's medical staff, who are responsible for medical screening and monitoring. (4) Document the screening and the referral. [synthesis for steps]
Example language (illustrative): "Some medications and health conditions matter a lot here. That's a question for your doctor, and I'd like you to ask them before you decide anything."
Watch for: the client minimising risk factors. Working: the client has spoken to a prescriber, or has reconsidered.

4.4 Clinician self-review before offering the service

Purpose / when: before starting this work, and when facing a new kind of request. Pilecki et al. include reflection questions on motivation, competence and risk tolerance. [source: Blossom summary of Pilecki et al. 2021]
Steps: [synthesis] (1) Review your training and supervision in this area. (2) Clarify your personal stance on psychedelics and how it could bias you either way. (3) Check your licensing board, employer and liability insurer's positions. (4) Consult a local attorney about criminal-law risk, as Pilecki et al. advise. (5) Arrange peer consultation.
Watch for: evangelism or alarmism in yourself. Working: you can describe risks and benefits evenly.

B. Pre-experience harm reduction (only for clients who have independently decided, or are entering a legal programme)

4.5 Balanced psychoeducation

Purpose / when: when a client says they plan an experience. PHRI covers effects, physiological responses, duration, risks, contraindications and interactions; Pilecki et al. add reviewing legal alternatives such as trials or legal ketamine treatment. [source: Blossom summaries of Gorman et al. 2021 and Pilecki et al. 2021]
Steps: [synthesis] (1) Ask what the client already knows and believes, including from media. (2) Correct misinformation in both directions. (3) Describe in general terms the kinds of psychological effects people report, including frightening ones, and that experiences are unpredictable. (4) Name legal alternatives and how to find trials. (5) Give no dosing, sourcing or preparation information. (6) Offer written reputable harm-reduction resources from your resource list (4.20).
Example language (illustrative): "People often expect it to be pleasant or life-changing. Some experiences are terrifying or confusing, and that can be part of it. Can we talk about how you'd cope with that?"
Watch for: requests for operational advice (decline and redirect to safety and meaning). Working: the client holds a realistic, two-sided picture.

4.6 Set, setting and intention exploration

Purpose / when: preparation. PHRI includes set and setting work: intentions, expectations and environment. [source: Blossom summary of Gorman et al. 2021]
Steps: [synthesis] (1) Explore current mindset: stressors, mood, recent events. (2) Ask about intentions and help phrase them as open questions rather than demands. (3) Explore expectations and what would count as disappointing. (4) Discuss the setting in safety terms: who will be present, whether they are trusted and sober, privacy, and how the person would get help. (5) Note any red flags in the setting the client describes (e.g. a facilitator with sexualised boundaries, pressure, isolation), and discuss.
Example language (illustrative): "If you set an intention, could it be a question you're open about, rather than an outcome you need?"
Watch for: rigid or grandiose intentions; unsafe settings. Working: intentions are flexible and the setting includes a reliable support person.

4.7 Safety and re-entry planning

Purpose / when: preparation. PHRI includes safety and re-entry planning; Pilecki et al. list environment, support people and not driving, and note drug checking where lawful has limits. [source: Blossom summaries of Gorman et al. 2021 and Pilecki et al. 2021]
Steps: [synthesis] (1) Identify a trusted, sober support person. (2) Plan transport so the client does not drive afterwards. (3) Agree when and how to seek emergency medical help and that safety comes before legal worry. (4) Plan the following days: rest, low demands, no major decisions. (5) Book an integration session. (6) Write the plan down with the client.
Example language (illustrative): "Let's plan the day after as carefully as the day itself. Who will be around, and when will we meet?"
Watch for: no support person; plans to use alone in unsafe settings. Working: a written plan exists and an integration appointment is booked.

4.8 Integration-resources inventory and six-facet balance check

Purpose / when: before the experience (Bathje et al. recommend starting integration planning during preparation), or at the start of integration. [source: Bathje et al. 2022]
Steps: (1) Inventory the client's resources: artistic skills, wellness practices, favourite natural places, supportive people and communities. (2) Rate, with the client, how active each of the six facets is in their life (mind/emotion, body, spiritual/existential, nature, relational/communal, lifestyle/action). (3) Plan time and physical space for integration. (4) Establish a relationship with an integration professional in advance so support exists if the experience is difficult. [source: Bathje et al. 2022] (5) Note gaps to address later. [synthesis]
Example language (illustrative): "Which parts of your life already help you digest big experiences? Where is there almost nothing?"
Watch for: a life with very few supports (go slower). Working: a concrete list of practices and spaces is ready.

C. Post-experience integration

4.9 Narrative capture ("returning")

Purpose / when: first integration session. Bourzat & Hunter's first step is capturing the narrative; the ACT-based protocol of Sloshower et al. also begins by eliciting the client's narrative. [source: Bathje et al. 2022]
Steps: [synthesis] (1) Invite the client to tell the experience in sequence, in their own words, before you interpret. (2) Ask for sensory, emotional and bodily details, and for moments they keep returning to. (3) Encourage a written or drawn record (journaling is among the practices listed by Bathje et al.). (4) Mark the moments that seem most charged, to come back to.
Example language (illustrative): "Take me through it from the beginning, as if I'm watching. What do you notice now as you tell it?"
Watch for: fragmented or very flat accounts (possible overwhelm or dissociation; slow down and ground). Working: the story becomes more coherent and less charged with each telling.

4.10 Non-directive validation

Purpose / when: early integration. This is the first ACE integration stage as summarised by Bathje et al. [source: Bathje et al. 2022]
Steps: [synthesis] (1) Reflect and validate the experience as real for the client, without endorsing or disputing metaphysical claims. (2) Name emotions you hear. (3) Hold back interpretation until the client asks for it or the story is complete.
Example language (illustrative): "That sounds like it was enormous, and also frightening. It makes sense that you're still sorting it out."
Watch for: your urge to interpret or reassure too quickly. Working: the client feels understood and offers more.

4.11 Experiential processing in the present moment

Purpose / when: when material from the experience is still active in the body or emotions. PHRI names experiential processing: staying with present-moment sensory and bodily experience. [source: Blossom summary of Gorman et al. 2021]
Steps: [synthesis] (1) Ask the client to notice what is happening in the body as they recall a charged moment. (2) Invite them to stay with the sensation, with curiosity, for a short period. (3) Track arousal; if it rises past tolerance, shift to grounding (feet, breath, room orientation). (4) Ask what, if anything, has shifted.
Example language (illustrative): "As you remember that part, where do you feel it? Can we stay with that for a few breaths?"
Watch for: rising panic, dissociation or flashback-like states; return to grounding and stabilisation. Working: the sensation moves or softens and the client feels more able to be with it.

4.12 Acceptance work with fear and avoidance

Purpose / when: when the client is frightened by what came up, or avoids remembering it. PHRI frames fear in terms of acceptance versus experiential avoidance; the ACE Acceptance triad groups defusion, present-moment focus and willingness. [source: Blossom summary of Gorman et al. 2021; Watts & Luoma 2020 abstract]
Steps: [synthesis] (1) Map what the client is avoiding (memories, images, sensations, conclusions). (2) Explore costs of avoidance. (3) Use defusion: help the client notice frightening thoughts as thoughts (e.g. "I'm having the thought that I'm going mad"). (4) Practise willingness: making room for the feeling during brief, chosen exposures to the memory in session. (5) Anchor in the present between exposures.
Example language (illustrative): "Your mind is telling you that this means something is broken in you. Can we notice that thought, and also what you are actually feeling right now?"
Watch for: if avoidance is part of PTSD-type re-experiencing, use trauma-focused stabilisation and consent before any exposure. Working: less avoidance and more curiosity about the experience.

4.13 Working with ego dissolution and "ontological shock"

Purpose / when: after experiences of losing a sense of self, or of having one's view of reality overturned. PHRI addresses fears of ego dissolution and ontological shock. [source: Blossom summary of Gorman et al. 2021]
Steps: [synthesis] (1) Normalise that such experiences are widely reported, and that many people find them meaningful over time. (2) Separate the experience from the conclusions the client drew (e.g. "nothing is real"). (3) Help the client tolerate not knowing, rather than forcing a final interpretation. (4) Reinforce ordinary anchors: routine, body, relationships. (5) If derealisation, depersonalisation or perceptual changes persist and impair functioning, refer for psychiatric assessment.
Example language (illustrative): "You don't have to decide today what it meant about reality. What helps you feel solid enough day to day?"
Watch for: persistent depersonalisation, sleep loss, emergent psychotic symptoms. Working: the client can hold the question open without distress.

4.14 Theme identification and symbolic work

Purpose / when: meaning-making phase. Bourzat & Hunter's second step identifies themes and decodes content; Bathje et al. list dreamwork, shadow work and interpreting symbols and metaphors. [source: Bathje et al. 2022]
Steps: [synthesis] (1) List recurring images, figures, emotions or messages. (2) For each, ask what it brings to mind in the client's life and history. (3) Treat interpretations as hypotheses the client tests. (4) Keep a dream journal if dreams pick up themes from the experience. (5) Summarise two or three themes in the client's words.
Example language (illustrative): "If that image were speaking about your life right now, what might it be saying?"
Watch for: Bathje et al. note Western participants may lack cultural references for some symbolic content; avoid imposing your own framework. Working: themes link to concrete life issues.

4.15 Psychodynamic exploration and transference work

Purpose / when: throughout. PHRI includes psychodynamic elements, attention to transference and countertransference, and to how psychedelics may loosen defences. [source: Blossom summary of Gorman et al. 2021]
Steps: [synthesis] (1) Link material from the experience to early relationships and current patterns. (2) Notice shifts in how the client relates to you (idealisation, wish to be guided, fear of judgment). (3) Name these gently and explore them. (4) Monitor your own reactions (fascination, envy, fear) in supervision.
Example language (illustrative): "I notice you're hoping I'll tell you what it meant. I wonder what it would be like to trust your own reading first."
Watch for: defences re-forming quickly or overwhelm from loosened defences. Working: insight about patterns grows alongside steadiness.

4.16 Spiritual and existential inquiry

Purpose / when: when content is spiritual, mystical or about death and meaning. Bathje et al. advise neither imposing spiritual interpretations nor avoiding them, and asking the client whether they want that focus. [source: Bathje et al. 2022]
Steps: [synthesis] (1) Ask whether the client wants to explore the spiritual side. (2) Use the client's own language and tradition. (3) Attribute concepts to their tradition rather than asserting them. (4) Where relevant, refer to a trusted spiritual adviser, chaplain or community elder chosen by the client.
Example language (illustrative): "Some people find these experiences spiritual, some don't. How do you see it, and would you like that to be part of our work?"
Watch for: spiritual bypass (using the experience to avoid problems) and grandiosity. Working: meaning that supports, rather than replaces, everyday life.

4.17 Revisiting the original intentions

Purpose / when: after the narrative is told. Bathje et al. list revisiting intentions as a first post-experience step. [source: Bathje et al. 2022]
Steps: [synthesis] (1) Read back the intentions the client set (from preparation notes, if any). (2) Ask how the experience relates to them, including unexpected answers. (3) Update the goals of therapy.
Example language (illustrative): "You went in wanting to understand your anger. What did you get, even if it wasn't what you expected?"
Watch for: disappointment that the intention was "not answered"; explore what did happen. Working: goals become clearer.

4.18 Values clarification and committed action

Purpose / when: later integration. The ACE Connection triad groups self-as-context, values and committed action; ACE moves to directive goal-setting; the ACT-based protocol moves to values, behavioural activation and mindfulness. [source: Watts & Luoma 2020 abstract; Bathje et al. 2022]
Steps: [synthesis] (1) Ask what the experience showed about what matters. (2) Turn each value into one small, specific, observable action for the coming week. (3) Schedule it, anticipate obstacles, and review next session. (4) Use self-as-context work to help the client hold changing self-images lightly. (5) Add brief mindfulness practice to sustain contact with the present.
Example language (illustrative): "If connection is what mattered most, what is one thing this week that would put that into action?"
Watch for: big impulsive plans (see 4.21). Working: small actions are done and repeated.

4.19 Integration practice plan across the six facets

Purpose / when: implementation phase, and after preparation (4.8). Bathje et al. recommend choosing relevant practices, committing to them regularly, and balancing them across facets and continua. [source: Bathje et al. 2022]
Steps: (1) Review the six-facet map with the client and choose one or two practices in under-used facets. (2) Balance the continua, e.g. some active and some receptive, some gentle and some stretching. (3) Set time and space (home, public or nature). (4) Identify supportive people and communities, and be cautious about sharing with people who do not understand or support the experience. [source: Bathje et al. 2022] (5) Review and adjust every few sessions. [synthesis]
Practice categories listed by Bathje et al. (choose with the client; not all are within a psychotherapist's scope, so refer where needed): artistic and creative work (drawing, mandalas, painting); music, singing, chanting, drumming; movement and somatic practices (yoga, dance, qigong, tai chi, walking, exercise, massage, bathing, floatation); diet and health; quiet time and rest; journaling, including dream journals; therapy approaches (group therapy, IFS, family constellation, ACT, mindfulness, values and emotion work, habit reinforcement); meditation, breathwork, body scan, walking meditation; nature contact (time outdoors, gardening, forest bathing); creating space and ritual (an altar or sanctuary, an orderly space); spiritual and existential practices (prayer, gratitude, inner listening, intention-setting, exploring death); dreamwork and symbolic work; community and activism (volunteering, service); relational practices (boundary-setting, letter-writing, reaching out, sharing circles, time with loved ones). [source: Bathje et al. 2022, Table 2 as summarised]
Safety: breathwork and floatation are non-drug altered-state methods; screen for cardiovascular disease, epilepsy, pregnancy, psychosis or bipolar history and unstabilised trauma before suggesting them. [synthesis] Meditation can bring up anxiety, depersonalisation or re-experiencing of trauma in some people; start briefly and monitor. [synthesis]
Example language (illustrative): "Most of what you're doing is thinking it through. What could you do with your body, or outdoors, or with other people?"
Watch for: overload (too many practices) or dropping them all. Working: a few practices kept up regularly.

4.20 Resource list and referral network

Purpose / when: set up before offering the service; use throughout. Pilecki et al. recommend a resource list rather than endorsing specific sources, and avoiding coordination with underground guides. [source: Blossom summary of Pilecki et al. 2021]
Steps: [synthesis] (1) Assemble reputable harm-reduction information sources, peer integration circles, crisis lines, prescribers and psychiatrists familiar with psychedelics, legal trials and programmes, and culturally specific supports. (2) Present it as information, not endorsement. (3) Review it periodically.
Example language (illustrative): "Here's a list of resources. I'm not recommending any one of them; it's a starting point for you to look into."
Watch for: pressure to recommend a specific guide or retreat. Working: the client uses resources independently.

4.21 Pacing big decisions and the "afterglow"

Purpose / when: after experiences with strong elation or urgency. PHRI notes heightened emotional sensitivity and a possible neuroplastic "afterglow" window; Bathje et al. warn about pressure to evangelise or make impulsive changes before integration. [source: Blossom summary of Gorman et al. 2021; Bathje et al. 2022]
Steps: [synthesis] (1) Name the window of heightened openness as an opportunity and a risk. (2) Agree a waiting period before irreversible decisions (leaving a job or partner, large financial moves). (3) Channel energy into small, reversible steps. (4) Review the decision after the waiting period.
Example language (illustrative): "This clarity is worth taking seriously. Let's test it by acting on it in small ways first."
Watch for: reduced need for sleep, pressured speech, grandiosity (assess for hypomania or mania). Working: decisions survive the waiting period.

4.22 Working with "sudden wellness" in the family system

Purpose / when: when rapid changes in the client unsettle partners or family. PHRI names "sudden wellness", where rapid motivational shifts can destabilise family systems. [source: Blossom summary of Gorman et al. 2021]
Steps: [synthesis] (1) Map who is affected and how. (2) Help the client explain changes without preaching. (3) Consider a joint session or couples referral. (4) Normalise that systems need time to adjust.
Example language (illustrative): "You've changed quickly, and the people around you may be catching up. What would help them understand?"
Watch for: conflict escalation. Working: relationships adjust without rupture.

4.23 Microdosing conversations

Purpose / when: when a client reports microdosing. Nielson's PESI seminar lists microdosing among clients as a topic; its content is not described here. [source: PESI course outline] [uncertain]
Steps: [synthesis] Use the same harm-reduction stance: explore motives and expected benefits, what the client notices, effects on mood and sleep, medication questions (refer to a prescriber), legal risk, and how they will judge whether it helps. Give no amounts or schedules.
Example language (illustrative): "What are you hoping it does for you, and how will you know if it isn't helping?"
Watch for: substituting for needed treatment; mood destabilisation. Working: decisions are informed and reviewed.

4.24 Clients from ceremonial, religious or retreat contexts

Purpose / when: clients who took part in Indigenous, religious or retreat ceremonies, at home or abroad. Bathje et al. note harms of extractive tourism and cultural mismatch. [source: Bathje et al. 2022]
Steps: [synthesis] (1) Ask about the community and who holds cultural or religious authority. (2) Do not interpret or reproduce ceremonial content; let the client share what they choose. (3) Support connection with that community's own integration resources where the client wishes. (4) Screen for exploitation or harm in the setting (pressure, boundary violations, medical neglect).
Example language (illustrative): "I don't want to put my framework over yours. Who in that community helps people afterwards, and would you want to stay in touch with them?"
Watch for: reports of abuse in the setting (see section 5). Working: the client feels respected and supported in both worlds.

5. Handling problems

Items with a [source] tag are named as problems in the sources; the responses are mine unless stated, and marked [synthesis].

Insights fade; client feels stuck [source: Bathje et al. 2022 on fading insights]

Response [synthesis]: return to the narrative record (4.9), pick one theme, and attach one small weekly action (4.18). Check the six-facet balance (4.19); stuckness often means all integration is cognitive. Accept that some experiences have no clear lesson and can still be honoured.

Unrealistic expectations: "it should have fixed me" [source: Bathje et al. 2022, psychedelics may reveal rather than heal]

Response [synthesis]: validate the disappointment; reframe the experience as having shown what needs work; set ordinary therapy goals. Watch for plans to repeat use as a fix, and discuss the risks of that pattern.

Overwhelm, persisting distress after a difficult experience [source: Blossom summary of Gorman et al. 2021 on acute distress; Bathje et al. 2022 on painful content and inadequate support]

Response [synthesis]: prioritise stabilisation: sleep, routine, grounding, support people, reduced demands. Slow narrative work (4.9) and use titrated experiential processing (4.11). Screen for suicidality using your standard risk assessment and safety planning, including lethal-means counselling (storage and removal). Refer to psychiatry if symptoms are severe, persist, or impair functioning.

Possible mania or psychosis versus an emergent spiritual experience [source: Bathje et al. 2022 note emergent experiences may be mistaken for mania or psychosis]

Response [synthesis]: do not decide alone. Assess sleep, functioning, insight, safety and family history; arrange urgent psychiatric assessment if there is risk, disorganisation, or loss of reality testing. Keep a respectful stance toward the client's meaning while ensuring medical care.

Persisting perceptual changes [synthesis] [uncertain]

Response: ask about visual or other perceptual changes since the experience; reduce anxiety about them; refer for medical and psychiatric assessment if persistent or distressing.

Inflation, evangelising, impulsive life changes [source: Bathje et al. 2022]

Response [synthesis]: use the waiting-period agreement (4.21); explore what the urge to convert others protects or expresses; assess for hypomania.

Family or partner destabilised by "sudden wellness" [source: Blossom summary of Gorman et al. 2021]

Response: see 4.22; consider couples or family referral. [synthesis]

Resistance or guardedness about disclosing illegal use [synthesis]

Response: restate confidentiality and its limits, your non-judgmental stance and what you document. Let the client control the pace of disclosure. Avoid recording unnecessary details of illegal acts; follow your jurisdiction's record-keeping rules. [uncertain: documentation law varies]

Non-adherence to integration practices [synthesis]

Response: reduce to one practice; link it to an existing routine; check fit with resources (Bathje et al. note people with fewer resources may need a gradual approach); explore whether the practice serves the client's values or yours.

Ruptures [synthesis]

Typical triggers: the client feels judged for use; the therapist appears over-enthusiastic or dismissive; the therapist declines a request (e.g. to sit with them or recommend a guide). Response: name the rupture, own your part, restate the role, and explore what the request means. Use transference work (4.15).

Request to attend, guide or "sit" for an illegal session; request to recommend or coordinate with an underground guide [source: Blossom summary of Pilecki et al. 2021]

Response: decline. Pilecki et al. advise against attending dosing, providing a venue, facilitating access or coordinating with underground guides; receiving unsolicited referrals is lower risk than making them. Offer harm-reduction education, safety planning and integration instead, and point to legal options (trials, regulated programmes where they exist).

Client in a regulated programme or trial [synthesis]

Response: with consent, coordinate with the programme's clinical team; do not duplicate or contradict their preparation; medical monitoring belongs to their medical staff; offer integration support that complements theirs.

Clinic or retreat provided little or no integration [source: Bathje et al. 2022 note some clinics offer little or none]

Response [synthesis]: offer integration (4.9 to 4.19); where appropriate, encourage feedback or a complaint to the provider or regulator.

Disclosure of abuse, sexual misconduct or medical neglect by a facilitator or ceremony leader [synthesis] [uncertain]

Response: treat as a trauma disclosure; prioritise safety and choice; inform the client of reporting options (police, the facilitator's licensing body in regulated programmes); follow mandatory reporting duties where they apply (e.g. vulnerable adults, minors). Do not pressure the client to report.

Cultural mismatch and appropriation [source: Bathje et al. 2022; Blossom summary of Pilecki et al. 2021 on DEI]

Response [synthesis]: ask what framework the client brings; adapt screening for racial trauma and mistrust; refer to culturally specific support; avoid presenting Indigenous practices as techniques.

Client with high-risk factors planning use [synthesis]

Response: give honest information about why the risk factors matter in general terms, urge medical consultation, discuss legal and lower-risk alternatives, and make a safety and re-entry plan if they proceed. Document the discussion.

Therapist's own use and self-disclosure [synthesis] [uncertain]

Response: decide in advance, with supervision, whether and how you would answer; keep disclosure brief and client-centred; never use your own experiences as a template for the client's.

Working across jurisdictions (telehealth, travelling clients) [synthesis] [uncertain]

Response: check the law where both you and the client are located; your licence usually applies where the client is.

Limits of single-theory models [source: Bathje et al. 2022 note ACT was not developed for psychedelics and may force fit; psychotherapy models may not cover the full range of experiences]

Response [synthesis]: use theory flexibly; add somatic, relational, nature-based or spiritual resources by referral when talk therapy alone isn't enough.

Sources

Sources

Cited only via the summaries above [uncertain]: the full texts of Gorman et al. 2021 (PubMed Central, DOI, Frontiers full page) and Pilecki et al. 2021 (PubMed Central, Springer).

Works cited

Bathje, G. J., Majeski, E., & Kudowor, M. (2022). Psychedelic integration: An analysis of the concept and its practice. Frontiers in Psychology, 13, 824077.
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, 645246.
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. doi:10.1186/s12954-021-00489-1
Watts, R., & Luoma, J. B. (2020). The use of the psychological flexibility model to support psychedelic assisted therapy. Journal of Contextual Behavioral Science, 15, 92–102.
Bourzat, F., & Hunter, K. (2019). Holistic Model for a Balanced Life, as described in Bathje et al. 2022. [uncertain]
Sloshower, J., et al. (2020). ACT-based protocol for psilocybin-assisted therapy for depression, as described in Bathje et al. 2022. [uncertain]
Coder (2017); Buller & Moore (2019); Westrum & Dufrechou (2019); Gandy et al. (2020); Ortigo (2021); Cohen (2017): further integration models listed in Bathje et al. 2022. [uncertain]

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