Integration Framework for the Psychedelic Journey

Building on her earlier session, entitled “Preparing for the journey: setting up for treatment,” Julie Megler, PHH-NP, co-founder, Sage Integrative Health, Berkeley, California, spoke to virtual attendees at today’s Sana Symposium about integration framework, including both “short-term integration” encompassing self-care, identifying what to integrate, and implementation, as well as “long-term integration” comprising re-evaluation and reciprocity.

Megler emphasized the importance for clinicians to build the framework for their clients as individuals because “this really sets the tone for how they hold the integration and their supportive structures for it.”

She continued by defining integration as “the process by which the material accessed and insights gained in an entheogenic [psychedelic] experience are incorporated over time into one’s life in a way that benefits the individual and their community.”

In the short term, integration begins with self-care, as Megler explains, “they call it a journey for a reason,” which includes sleep and rest, nourishment, low stimulation, and slowing the transition back daily responsibilities, ideally taking time off work for a few days to up to a week afterward.

Next, clinicians need to assist their clients in identifying what to integrate. Megler described this process as “recount[ing] themes or insights that left an impression on them in their psychedelic experience, and then you’re going to help them discern and translate those lessons.” She continued that once the lessons are identified it is important to help clients relate them to what the initial intention was as well as their inventory, or key goals, for the process. Finally, for clinicians to help clients prioritize these lessons as they integrate them into their daily lives.

Megler stressed that “you’re going to want to encourage them to wait 4 to 6 weeks before [making] really significant life changes because things can evolve or change or land differently after some time has passed.”

Megler then discussed the last short-term integration phase: implementation. She described this as “really bringing the mystical into the practical.” During this stage, the clinician should help their client develop practices based on their priorities for integration. Also, creating positive reinforcement for them with goals that are “practical, attainable, and enjoyable.” Last, find ways to balance the 6 different aspects of inventory, which she classified as “mind, body, spirit, community, environment, as well as the heart.”

Megler next moved to discussing long-term integration in terms of re-evaluation and a time of reflection on how the client is doing with their implementation. A time to assess if their goals are achievable and if anything needs to adjusted or reprioritized. It is also an opportunity to acknowledge if there is material that is making the client uncomfortable and too difficult for them to integrate, or if there is new material they want to discuss and work on as well.

“This is really a time for the client to focus on what’s working and what’s not for them, and for you guys to adjust the integration approach accordingly,” Megler explained.

She concluded her session by talking about reciprocity as the final piece of long-term integration with the notion of “giving it back and paying it forward.” The idea is that “once you’ve integrated and experienced the benefits of psychedelics, how do you bring that into your community and share that in some way?”

Megler explained that as the clinician, it is important to help the client find a way to share their experience that will be well-received to the outside community since psychedelics has not been fully accepted. This will also take cultural aspects into account.

Reciprocity also includes the idea of accessibility. Megler acknowledged that as there is no insurance reimbursement for psychedelic-assisted therapy and it is expensive, so most clients are middle-class, White individuals. She briefly touched on the stigma surrounding these types of therapies regarding people of color and marginalized populations who have been targeted by the drug wars, and how these individuals do not feel safe using this type of treatment.

Megler then spoke to clinicians directly regarding advocating for insurance reimbursements by stating, “the more journal articles that we write, and the more research that we publish around psychedelics, the more that is going to get out there and get approval, and eventually lead to insurance panel reimbursements.” She finished by stating, “So, that’s kind of our duty as the clinicians to help with the reciprocity piece.” 

Reference

Megler JD. Best practices for navigating follow-up care with patients. Presented at: Sana Symposium; September 17-19, 2021; Virtual.