Recent years have seen a global explosion in the field of psychedelic research, popularizing of use of non-ordinary states of consciousness to aid in PTSD, anxiety and depression, end of life and a growing sense that the use of substances like MDMA, psilocybin and others may become mainstream approaches to treating persistent challenges in these marginalized populations. As we destigmatize these treatments, as we see more demand, we will also witness a need for more trained professionals who can support these experiences, capable of holding these spaces1 and an emergence of programs designed to safely facilitate experiences of non-ordinary states of consciousness.
Marc B. Aixalà is an engineer, psychologist and psychotherapist. His collaborative work with the International Center for Ethnobotanical Education, Research and Service (ICEERS) spans a decade of supporting psychedelic experiences, ensuring the relative safety and efficacy of client experiences, through practicing integration therapy. His training includes Holotropic Breathwork facilitator, MAPS certified MDMA assisted psychotherapy for PTSD and the therapeutic use of Non-Ordinary States of Consciousness. Involved in the first medical trials utilizing psilocybin for treatment-resistant depression, he continues to be involved in clinical trials researching psychedelic substances and works as a psychologist in his private practice in Spain.
This book review will focus on interpreting the core principles of Aixalà's exploration of the ways in which therapists might support clients undertaking psychedelic experiences, often when they themselves have not been present for the client's experience.
Integration for harm reduction, and self discovery
Aixalà begins with an exploration of the origins and evolution of psychedelic therapy. He describes two setups initially favored by psychotherapists (and later blended in some cases). In the first method, termed psycholotic therapy, a low dose administered to participants during therapy largely discounts the necessity of specific integration work, due to the incorporation of substances into an ongoing therapeutic arrangement. Integration is a natural part of the process. In the second method, termed psychedelic therapy, a high dose ‘trip’ is followed by sessions focused on supporting a participant in their meaning-making of the psychedelic experience. In the case of psychedelic therapy, there may be a need to support participants in either making the most of their positive experiences, or support the processing of challenging, personal, or even harmful practices.
Integration is framed as the sense-making process for participants, and Aixalà is clear to point out on multiple occasions that what truly matters is the participant's sense making, the narrative that is constructed which has meaning for them. He reiterates more than once that whether or not therapists might make their own sense of a client's interpretation and fit it within models of practice or the literature is immaterial to good client outcomes. There is a visible, deep respect for his clients and compassion in approaching integration. His use of metaphor adds color to describe the intent behind what we are trying to do with integration – putting together a puzzle, planting seeds, decompressing after intense periods to re-establish normal. At every moment, we witness an approach built upon the appreciation of variability and a humble capacity to work with this ambiguity to support clients.
We see these personal qualities manifest in Aixalà’s weaving of various techniques to later build strategies that support clients in various scenarios – perhaps a negative experience due to poor preparation, a pre-existing traumatic injury, unresolved experience, traumatic dissociation. In each scenario there is a blending of deliberate guidance to support restoration of challenging situations, that grows into supportive self discovery and techniques that support deep learning, personal self-reliance and resilience. I sense a lived experience borne of working with many many people, that ‘challenging’ does not equal ‘bad’, but rather these difficult trips are opportunities for our personal exploration of self. There is also an emphasis on the ‘self-work’ of the therapist, to walk alongside clients through their process.
A new paradigm for integration
This appreciation and respect for variety, an active cultivation of variability, is further enhanced in Aixalà's proposal of a new paradigm for integration work. He explores constructivism as a philosophical approach. Wendy Makoons Geniusz, indigenous scholar translates a beautiful Anishinaabeg word gaa-izhi-zhaawendaagoziyaang as knowledge lovingly given to us by the spirits (Geniusz, 2009, p. 67), and I am curious to hear how constructivism “that springs from the assumption that all knowledge is built by humans.” (Aixalà, 2022, p. 94) might interact with this indigenous way of knowing. In any case, Aixalà proposes constructivism as a way of incorporating multiple realities, world views and both therapeutic, but also ontological (spiritual) explorations in approaching psychedelic integration work. His commitment to continuing to incorporate variability is apparent.
What I appreciate most is that Aixalà offers a non-directive foundation to this work. Whilst there is a clear willingness to engage, and deliberate actions, he suggests adaptive approaches in a way that build the participants' own sense of empowerment and resilience. Each individual's situation is unique – their preparation, experience, and now the integration necessary for them to engage in productive meaning making for themselves. On more than one occasion, there is a deliberate focus on diminishment of therapist as knowledge-giver – honoring client perception, inherent wisdom and the self-as-healer. These themes are pervasive in psychedelic literature today and challenge the paradigm of a Western medicalized model, in which healing is externalized and much emphasis is often placed on the substance, rather than the substantive work of change. Aixalà's paradigm offers an opportunity to take meaningful action today to support clients, whilst allowing the room for growth and development as new information, new knowledge emerges, whether of the self, or of the practice.
In a world as turbulent as ever, Aixalà's messages of adequately integrating experience, and building a meaningful narrative for the events of our lives, are more important than ever. Further, as psychedelic therapies emerge and demand grows, this book offers foundational knowledge for therapists and non-therapists alike, in considering the context in which these experiences occur, and how we might best support participants in their self development, or restorative journeys.
References
Aixalà, M. (2022). Psychedelic integration psychotherapy for non-ordinary states of consciousness. Synergetic Press.
Geniusz, W. M. (2009). Our knowledge is not primitive: Decolonizing botanical Anishinaabe teachings. Syracuse: Syracuse University Press.
Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies (MAPS) has been repeatedly outspoken about the bottleneck being not the manufacture of psychedelic substances as demand grows, but the need for licenced, trained professionals (https://psych.global/rick-doblin-on-35-years-of-maps-opportunities-for-psychedelic-investors-and-the-path-to-creating-a-strong-industry/).
