With an uptick in the microdosing trend, the decriminalization movement, federal psychedelic research, and media like Michael Pollan’s How to Change Your Mind, more people are becoming curious about the mental health applications of psychedelics.
But despite the public’s growing curiosity around substances like shrooms or MDMA, there’s a gaping hole in the medical model, whereby mental health professionals may not be adequately equipped to help clients—who may be experimenting with psychedelics on their own time—integrate their often profound, ineffable experiences into mundane life.
“We know that 10 percent of the U.S. population has tried psychedelics at some point in their life, and I’d venture to guess that the number will increase,” says psychologist Dr. Ingmar Gorman, who, along with fellow psychologist Dr. Elizabeth Nielson, co-founded Fluence, a newly launched program to train mental health professionals in psychedelic integration.
Simply put, “psychedelic integration” is a growing field of psychology that helps people glean insights from their psychedelic experiences in order to use them as tools for growth. While integration can include practices like yoga, journaling, meditation, mindfulness techniques, or listening to music that was heard during the psychedelic trip, the idea is to help individuals tap into their inner healer.
Gorman describes psychedelic integration as a transtheoretical approach that highlights a therapeutic stance and relationship with the patient, rather than prescribing specific required techniques. The burgeoning field also incorporates mainstream psychotherapy practices, like mindfulness-based cognitive therapy or cognitive behavioral therapy, to help patients arrive at their own truths. The overall goal of Fluence, Gorman says, “is to make information available to clinicians so they can then adapt it to their own psychotherapeutic orientation.”
For clinicians like Rebecca Kronman, an LCSW who practices in Brooklyn and studied integration with Gorman and Nielson in 2018, the training has been invaluable. She says her practice has exploded since the release of Pollan’s bestseller, estimating that about 50 percent of her patients are seeking guidance to make sense of their psychedelic insights (including challenging emotions that were stirred up by trips, both in the short term or even several months or years later).
But, Kronman points out, it is important for therapists to be tuned in to some key distinctions between mainstream and integration therapy. “It is accessing new research, and accessing spirituality differently,” she says. “It opens up indigenous knowledge and wisdom, and exposes you [the therapist] to things you need to know outside of mainstream therapy, like harm reduction.”
50 percent of Kronman’s patients are seeking guidance to make sense of their psychedelic insights.
Before creating Fluence, Gorman and Nielson both worked on clinical trials for MDMA and psilocybin, respectively. They also worked as clinicians at the Center for Optimal Living, a New York City-based treatment and training center focusing on Integrative Harm Reduction Therapy—a practice aimed at reducing the negative consequences associated with drug use. “The Center had previously done workshops where they taught integration skills for the public,” Nielson says. “But I really wanted to shift the focus to making the trainings for professionals because I felt that there was a real lack of education for the potential for harm reduction (a set of strategies and ideas intended to reduce negative consequences associated with drug use), and the potential for clinicians to integrate those [psychedelic] experiences in therapy.”
Gorman and Nielson point to the increasingly popular ketamine treatments as an area where clients are going therapeutically unsupported. Typically, patients who are prescribed ketamine receive a series of infusions over a period of two to six weeks. Gorman and Nielson say that the effects for each person are hard to predict, but could range from dissociative to profoundly psychedelic—even at the standard .5mg/kg dose. Finding a clinician who can help integrate the profundity of the experience, however, is left entirely to the patient. (Read more about that here.)
Nielson notes that most mainstream therapists don’t really know how to have fruitful conversations with patients following their psychedelic experiences, explaining that patients could have heightened anxiety, or attempt to medicate or write off their psychedelic insights as a “drug experience,” which may further pathologize their symptoms. “Patients need to be engaged and involved in their process, and those are the kinds of things we’re teaching therapists,” she adds.
As part of their psychedelic integration training, Fluence’s two-day “general introduction” workshop includes about 10 hours of lectures and four hours of role-playing. Gorman says more experienced mental health professionals can participate in a consultation group where they can discuss specific clients and receive support from more experienced clinicians.
Fluence also has a 10-week online course in the works that will feature mock therapy sessions, as well as an advanced class that dives even more deeply into the role of an integration therapist and the issues they may tackle, such as a patient’s desire for ego dissolution.
Fluence also offers continuing education (CE) credits that every licensed mental health professional must obtain to continue their professional practice, a step that Gorman believes is crucial to legitimizing and professionalizing integration therapy.
According to Gorman and Nielson, there are some tenets that every integration specialist should uphold, such as not administering psychedelics, no “trip sitting,” nor directing patients to underground therapists or legal retreats in countries like Costa Rica or Peru.
Not everyone who trips, however, will end up working with a psychedelic integration therapist—at least, not initially. DoubleBlind co-founder Shelby Hartman spent two years attempting to integrate her psychedelic experiences with a mainstream therapist specializing in cognitive behavioral therapy, before a friend finally referred her to a somatically-trained underground integration therapist. Though she describes the mainstream therapist as very sharp, she says they didn’t make much progress together. “Psychedelics are an incredibly profound part of my journey,” she says. “So, it did feel like there was something always kind of missing.”
With the integration therapist, however, she says that in just one session she had several breakthroughs. “It changed everything when I began working with someone who had personal experience with psychedelics and could help me recall what had happened to me during my trips,” she says. “I’ve been doing psychedelics for 10 years and there was so much from trips, long ago, that I had yet to fully process.”
“It changed everything when I began working with someone who had personal experience with psychedelics and could help me recall what had happened to me during my trips.”
Fluence trains clinicians (more than 500 so far) to not only help well-functioning patients like Hartman integrate their psychedelic experiences, but also to assess clients for “red flag” behaviors like withdrawal or mood changes, to outline contraindications and high-risk cases for those contemplating psychedelic use, and to clarify the role of the therapist in an individual’s integration psychotherapy process.
Gorman predicts that the growing demand for psychedelic integration therapy will further legitimize psychedelic-assisted therapy more broadly. “If things head in the direction they’re going and [psychedelics] become prescribable, you’re going to have to train therapists to do psychedelic therapy,” he says. “We are going to need to educate not just the therapists, but also the wider group of psychiatric professionals. It could be a problem if you have psychedelic therapies available, but the larger medical infrastructure isn’t aware.”
Gorman and Nielson reiterate that psychedelic integration is an inquiry process that allows patients to find their own truths—but working with a trained integration therapist may help guide patients toward making their own meaning.