In Psychedelic Therapy, Don’t Forget the ‘Therapy’
By: Jane Garnett
Tags: Psychedelics, Mental Health, Brain, Therapy, Life

In Psychedelic Therapy, Don’t Forget the ‘Therapy’

A wide gulf lies between what we ‘see’ on psychedelics and what we do with what we saw

Image: nutcat/Getty Images

Twenty minutes late, Matt (whose name was changed for privacy) stumbles into my therapy office, dives onto my green couch, stretches out like a Freudian pro, and buries his face in his hands. Matt, a renowned New York wellness entrepreneur, had found me through the intersection of Burning Man and the plant medicine communities — where most of my clients come from. This niche has found me organically and inevitably; I’ve had a private practice as a marriage and family therapist for 13 years, and for 10 of those, I’ve been on my own parallel personal journey of exploration both as a burner and a psychonaut (sailor of the mind).

“Stupid. Stupid. Just stupid!” Matt groans.

“What?” I ask.

“I came to you to talk about psychedelics, but now you know my dirty secret. I can’t believe I came in today. I haven’t even slept. Fucking cocaine.”

Matt had come to me to talk about his experience on ibogaine, a natural psychoactive medicine derived from the West African shrub iboga and increasingly used by patients trying to kick drug addictions. It clearly hadn’t worked for him, and it occurs to me that he might still be high on coke. And if he’s high, it’s unethical to treat him. But at this moment, other issues take precedence: the shame spiral he’s in, the fact that we’re already 25 minutes into a 50-minute session, and the reality that I couldn’t move his huge body off my sofa if I tried.

Above all, a more universal question is nagging me: As more people turn to psychedelic-aided therapy, why are so many forgoing the necessary follow-up to process these experiences? That follow-up, known as psychedelic integration, is how we metabolize the supranormal phenomena we’ve experienced while tripping and fold it back into “normal” life. Integration takes real time and is likely to be bumpy. Old traumas can suddenly surface hours or days after a trip; we can be suddenly flooded by unmet needs or pain we thought we’d left in the past.

This is something I know firsthand. Ayahuasca helped me become a better mother, a better ex-wife, and a better therapist. The “medicine” reflected back to me the power of compassion and how to cultivate it. Iboga, a medicine that originated in Gabon, showed me my own darkness and reconnected me to my creativity. Psilocybin has added depth and perspective to my meditation practice. And I’m still processing my one and only LSD trip that I had a little over a year ago. I know that without proper resources in place to guide them through the aftermath, people often struggle to reconcile life-changing “medicine experiences” with their actual lives. That is, a wide gulf lies between what we “see” on psychedelics and what we do with what we saw. Mind the gap, as we say in London, where I’m from.

Psychedelics are proliferating both in and out of therapeutic settings; they have transcended hippies’ “tuning in and dropping out” and become increasingly accepted as mental health treatments. As the Multidisciplinary Association for Psychedelic Studies (MAPS) website puts it, “With both MDMA and psilocybin on the precipice of approvals as mainstream medicines, and several leading universities opening dedicated psychedelic research facilities, the story of the last 10 years has been one of profound breakthrough.” Psychedelic wellness solutions are featured in Michael Pollan’s bestseller How to Change Your Mind, Gwyneth Paltrow’s The Goop Lab, and Anderson Cooper’s segment on the John Hopkins study of psilocybin for mental health.

The best thing about psychedelics may also be the worst: Psychedelics tear down your defenses fast.

A study by Scientific American shows a 223% rise in LSD use among 35- to 39-year-olds between 2015 and 2018. That startling number only proves what I’m seeing in my own psychotherapy practice in Los Angeles: a striking influx of people who have taken psychedelics for therapeutic purposes. Too many of them, I’ve found, are seeking help weeks or months or years after life-changing experiences on ayahuasca, psilocybin, or iboga. And I’m increasingly concerned. So many patients are struggling.

A therapeutic trip can trigger a dramatic shift — and that’s the point. People break addictions, heal traumas, and mend relationships immediately after psychedelic experiences. But over time, many become jaded, disappointed, confused, and destabilized. The best thing about psychedelics may also be the worst: Psychedelics tear down your defenses fast. People often finish a trip and leap into life-changing decisions — divorcing their spouses, leaving their jobs, or conceiving children. Many people don’t regret those decisions, but inevitably, after time has passed, some do.

Which brings us back to my patient Matt, the wellness entrepreneur who can’t stop snorting cocaine. “What did iboga show you about yourself?” I ask him. Considered the “grandfather of psychedelics” (ayahuasca is the “grandmother”), iboga is a traditional West African root bark used in low doses to retain alertness while hunting and in high doses to cause near-death experiences for the purpose of spiritual awakening. Administered legally in sobriety clinics throughout Mexico, iboga is also one of the most powerful addiction interrupters we know of. It successfully got Matt off coke a couple of times, but he avoided the after-care protocols, including therapy and group support, and his abstinence didn’t stick. He had planned to take iboga again, he tells me, except two weeks ago, he discovered he’s a heart attack candidate, so it’s no longer safe.

My own 48-hour iboga experience was a mixture of torture and revelation. I relived the shadows of my childhood, hatred, and rage over my parents’ divorce and my father’s addictions — all ugly emotions my upbringing had trained me to hide. Iboga revealed a split in me: the part of me that was on board with my life and the part of me that wanted out. It was the most confronting psychedelic experience I’ve ever had — wildly disorienting, exhausting, nauseating, and full of all the traumas I hadn’t been able to look at square in the face despite years of therapy. When it finally ended, I was overwhelmed with gratitude, as if I’d been given a permission slip to break out of the old family narratives and rewrite my future.

We can open our hearts, be in community, and rip the lid off our failing civilization. But then we return home, and the real work begins: We must integrate.

Experience has taught me what to do after a trip, and privilege has allowed me to do those things. I have the resources to receive therapy, get a massage, or do a meditation retreat. I have the know-how and education to keep researching. I’ve gotten to know the cutting-edge thinkers of the psychedelic community through conferences, networking, and reading (not that any of that guarantees a lack of turbulence).

Even among those of us who have the material resources and time to process our experiences, many of us don’t have the communal models of indigenous communities. In plant medicine circles in the U.S., in contrived ceremonial settings, we may get a glimpse of what life could look like. We can open our hearts, be in community, and rip the lid off our failing civilization. But then we return home, and the real work begins: We must integrate.

Matt turns to me, his face locked in unexpressed emotion. I know that look: the dam before it bursts. Then he starts sobbing so hard, he can’t speak and can’t stop. He covers his heart with his hand, his whole body shaking. “It showed me this,” he says. And for a minute, I get to see it: the excruciating vulnerability that is so often at the center of personal chaos. Matt has a vulnerable heart, figuratively and literally under threat of attack. Iboga has helped expose this reality, but what should he do about it?

I outline a treatment plan for Matt that doesn’t involve iboga. To quit cocaine and find more healthy coping mechanisms, he would most likely need to enter a sobriety program or curate a team of mental health professionals to help him stay clean. Most challengingly, Matt would need to commit to sobriety. Even then, there would be no guarantee of success.

Psychedelics are immensely helpful in getting under our defenses and providing a simplicity of vision that adults can’t normally access. In this sense, they are more powerful than the greatest therapists. But when they wear off, there’s not only what’s been exposed but the rest of life to deal with also: the to-do lists and taxes and physical needs. As Buddhist practitioner and mindfulness expert Jack Kornfield put it in the title of his book: “After the ecstasy, the laundry.” Or, in Matt’s case, rehab.

For anyone new to psychedelic healing, my advice is to plan for integration before even starting the journey. I’d recommend thinking carefully through three categories: set, setting, and support.

Set: Mindset is all-important. Having a clear and positive intention can be very helpful. It makes you more of an empowered participant in your journey, inviting in more purpose as well as a sense of a home base to return to — which could be a mantra of some kind or a question that you lead with. Music also makes a huge difference to a journey. If you are selecting the music yourself, choose tunes that speak to your heart and relax your nervous system.

Mindset is all-important. Having a clear and positive intention can be very helpful. It makes you more of an empowered participant in your journey, inviting in more purpose as well as a sense of a home base to return to — which could be a mantra of some kind or a question that you lead with. Music also makes a huge difference to a journey. If you are selecting the music yourself, choose tunes that speak to your heart and relax your nervous system. Setting: Who you have your experience with and where is important. Pick a location that feels safe and quiet and that, ideally, you have a sense of connection to. If you’re sensitive to other people’s energy, do not do psychedelics in large groups. Being in or near nature can feel very supportive even if it just means being close to a plant or a tree. If you’re journeying away from home, make sure you have a solid plan of how to get there and back. (Needless to say, it should not involve you driving.)

Who you have your experience with and where is important. Pick a location that feels safe and quiet and that, ideally, you have a sense of connection to. If you’re sensitive to other people’s energy, do not do psychedelics in large groups. Being in or near nature can feel very supportive even if it just means being close to a plant or a tree. If you’re journeying away from home, make sure you have a solid plan of how to get there and back. (Needless to say, it should not involve you driving.) Support: Research the shaman or therapist who will act as your guide. Make sure there’s someone else you’re checking in with on either side of your experience — a good friend or a wisdom figure in your life. It’s always valuable to have another perspective and not make your shaman or therapist your only source of feedback and or authority. Make sure you have time carved out on the back end of a journey to go slow and talk with a counselor if you can. Journaling, meditation, and spending time in nature all help with processing psychedelic downloads as well as allowing new neural pathways to be reinforced.

A trip is like any voyage: It requires preparation, time for proper digestion.

For further information and support, InnerSpace Integration hosts a network of resources along with psychedelic integration circles. Tam Integration offers a collection of trip sitter manuals and guides. For those who want to go deeper, Psychonautdocs.com has curated a wealth of essays and studies on a range of psychedelics.

Most importantly, hold off on big decisions after life-altering experiences. A trip is like any voyage: It requires preparation, time for proper digestion, and a willingness to not only surrender to the experience but to allow the necessary time to change your life.