Abstract
Background
While psychedelic substances are extensively studied through the lens of various academic disciplines, their impact on the therapeutic practice of mental health professionals is yet to be explored. This firsthand experience is deemed crucial for effectively assisting patients in the process of integrating a psychedelic experience.
Aims
The aim of this study was to explore the psychological and spiritual dimensions of psychedelic integration among mental health professionals, focusing on understanding how transformation and insights influence their clinical work.
Methods
Utilizing a phenomenological methodology, interviews with eight mental health professionals with substantial first-person experience with psychedelics were conducted.
Results
Our findings indicate a potential, enduring, positive impact of psychedelic meta-integration on the practice of mental health clinicians. The data analysis yielded a multi-faceted model encompassing key aspects of human life including interpersonal and emotional development, relationship with death and nature, concepts of love, meaning, and spirituality, along with elements pertinent to therapeutic work. This comprehensive model integrates these diverse dimensions, offering a holistic understanding of the impact of psychedelics on both personal and professional realms.
Conclusions
The findings of this study lend support to the notion that health professionals involved in clinical work encompassing psychedelic integration should themselves have undergone induced altered states of consciousness, not only for a better empathetic understanding. This might be also predicated on the intrinsic positive transformative effects on their human capacities and as therapists. This dual benefit underscores the importance of personal experience in the effective facilitation of psychedelic integration in clinical settings.
Introduction
In the realms of psychedelic research, therapy, and recreational use, the term 'integration' denotes the process by which individuals derive meaning from their experiences and incorporate these insights into their daily lives. The term ‘integration’, originating from the Latin ‘integrare’ meaning to ‘make whole’ or ‘begin again’, suggests that aligning our beliefs, attitudes, thought processes, and actions with the insights gained from a psychedelic experience is a step towards achieving a sense of wholeness. In this study, we distinguish between three different components of the integration process: The amalgamation of various elements of the psychedelic experience into a unified narrative; the incorporation of this coherent narrative into the individual's everyday life; and the incorporation of multiple integration processes into the individual's ongoing psycho-spiritual development, a process we termed ‘meta-integration’.
One of the most intriguing aspects of psychedelic drugs is their ability to enhance meaning (Hartogsohn, 2018), a quality that was brought back to the awareness of mainstream science through the widely cited work of Griffiths, Richards, McCann, and Jesse (2006), who showed that psilocybin can occasion mystical experiences, that are not only deeply meaningful but also have a long-lasting impact on personality. As operationalized by the Mystical Experience Questionnaire, these are profound, meaningful experiences characterized by a sense of unity, sacredness, intuitive knowledge, transcendence of time and space, deeply felt positive mood, and ineffability (Barrett, Johnson, & Griffiths, 2015). Carhart-Harris et al. (2014) showed that the psychedelic state is characterized by unconstrained cognition and high-entropy neurodynamic and that when the person is shifting back to his/her ordinary state of consciousness, his/her brain is going through a process of reorganization (entropy-suppression). Furthermore, the term 'integration' not only pertains to the assimilation of various aspects of the experience into a cohesive narrative but also extends to the incorporation of this narrative into the individual's daily life.
In a recently published study, perceived personality changes attributed to intense psychedelic experiences were found, with eight identified thematic factors: Unitive Spiritual, Gratitude Absorption, Purpose Freedom, Compassion Understanding, Emotional Stability, Openness Perspective, Connection to Self, and Neuroticism Caution (Weiss, Sleep, Beller, Erritzoe, & Campbell, 2023). The authors also mentioned previously published findings of subjective changes associated with psychedelic experiences: change of life priorities toward authentic values (Belser et al., 2017; Kavenská & Simonová, 2015; Shaw, Rea, Lachowsky, & Roth, 2023; Watts, Day, Krzanowski, Nutt, & Carhart-Harris, 2017); increased ability to surrender (Belser et al., 2017; Kavenská & Simonová, 2015; Presser-Velder, 2013; Shaw et al., 2023); connectedness (Belser et al., 2017; Kjellgren & Soussan, 2011; Watts et al., 2017); relational embeddedness (Belser et al., 2017; Bersani et al., 2014; Kavenská & Simonová, 2015); present-focused awareness (Kjellgren & Soussan, 2011); increased awareness of denials concerning maladaptive behavior (Loizaga-Velder & Verres, 2014).
The question of adequacy, legitimacy, and utility of personal experience with psychedelics among psychedelic therapists remains unresolved despite its undeniable importance. Experiential learning, which is common and occasionally mandatory in the broad field of psychotherapy, is notably scarce in the field of psychedelic assisted psychotherapy.
Over the years, researchers and therapists have described their use of psychedelics and their potential value to their work (Blewett & Chwelos, 1959; Hofmann, 2005; Leary, Metzner, & Alpert, 2000). This has also been shown in a retrospective study on self-experiments with LSD in former Czechoslovakia (Winkler & Csémy, 2014). We know of several cases where self-experience with the substance was allowed as part of the training and described in the literature, at the Spring Grove Research Center (LSD) (Yensen & Dryer, 1992), at the Multidisciplinary Association for Psychedelic Studies (MDMA) (NCT01404754), and in Canada where 16 health professionals could experience the effect of psilocybin as part of their training program (Schlag, Aday, Salam, Neill, & Nutt, 2022). There are also training programs in the US allowing self-experiencing with ketamine (Nielson, 2021). Recently, a survey conducted among 32 psychedelic facilitators of Usona Institute's psilocybin for depression trial found that a vast majority had personal experience with psychedelics (88%) and that the most common intention for it was personal development and spiritual growth (Aday et al., 2023). It is also noteworthy that patients who go through psilocybin-assisted therapy possibly prefer therapists with personal experience (Earleywine, Low, Altman, & De Leo, 2022). Interestingly, as we did in our presented study, a doctorate dissertation looked at the lived experience of clinicians who have had spiritually significant psychedelic experiences, suggesting such experiences may be beneficial for mental health clinicians (Rajcok, 2022).
Our study aimed to investigate the personal and professional effects of multiple recreational psychedelic experiences among Western mental health professionals. These experiences, elicited by a variety of substances in different settings over their lifetimes, were part of a process we have termed 'meta-integration'. This term denotes the comprehensive integration process that encompasses a range of psychedelic experiences.
Methods
The methodology used for this research is Descriptive Phenomenology. The aim of this method is to provide a rich, detailed description of the phenomena from the perspective of those who have experienced it (Moustakas, 1994). Its purpose is to give the reader a “grasp of the very nature of the thing” (Van Manen, 1990, p. 177). This approach is focused less on the interpretations of the researcher and more on a description of the experiences of participants. It comprises a concept called “bracketing” in which the researcher sets aside his own experiences, as much as possible, to take a fresh perspective towards the phenomenon under examination. Nevertheless, the organization of qualitative data into various themes is naturally interpretive and analytical to some extent rather than strictly descriptive. Data segments were sent back to participants for their comments, and no significant adjustments were required. Ethical approval for this study was granted by Middlesex University.
Data collection
Data was collected by conducting in-depth multiple interviews using a semi-structured protocol. The open-ended pre-established questions (Appendix 1) allowed participants (Table 1) latitude and freedom and left them room to share relevant material that could not have been anticipated by the researcher (Hesse-Biber & Leavy, 2011). Moustakas' (1990) notion that “the data generated is dependent upon accurate, empathic listening; being open to oneself and to the co-researcher… and being skillful in creating a climate that encourages the co-researcher to respond comfortably, accurately, comprehensively, and honestly in elucidating the phenomenon” (p. 48) was informing our attitude during these interviews. This way, the emerging data reflects the participants' lived experience and free-flowing narrative, and not the researchers' assumptions (Creswell, 2013). All interviews were tape-recorded and transcribed.
Participant description
Name | Age | Gender | Occupation | YOE as a Therapist | YOE with Psychedelics |
Greta | 33 | F | C. Psychologist | 7 | 18 |
Timothy | 47 | M | C. Psychologist | 10 | 22 |
Sarah | 45 | F | C. Social Worker | 20 | 23 |
Jane | 36 | F | C. Social Worker | 7 | 14 |
Laura | 59 | F | Psychotherapist | 27 | 8 |
Robert | 46 | M | Psychotherapist | 12 | 28 |
Isaac | 32 | M | Psychiatrist (In Training) | 3 | 5 |
Alfred | 42 | M | Psychiatrist | 11 | 4 |
Note. YOE – Years of Experience, C. Psychologist – Clinical Psychologist, C. Social Worker – Clinical Social Worker. YOE with Psychedelics was calculated from the time of first psychedelic experience, although it is important to note that many participants took years-long breaks since.
Ethical considerations
All collected data was securely stored in a password-protected folder. Furthermore, participation forms were stored in a locked drawer. We maintained a neutral approach regarding the value, whether positive or negative, of recreational drug use; participants were not encouraged to use these substances at any stage. We informed participants that they had the option to terminate the interview at any point and possessed the right to withdraw their data from the study at any time before submission. This study was approved by the Ethics Committee of Middlesex University.
Data analysis
Data analysis began by reading all transcripts twice. The rest of the analysis process was done via MAXQDA, a program for qualitative data analysis. Once all transcripts were imported into MAXQDA, the coding process began. During this process, where data is fractured, conceptualized, and integrated to form a theory (Strauss & Corbin, 1998), each interview was read for the third time, while categorizing each sentence or paragraph into a relevant code that carried a title, a short explanation, and a color. Codes were created during the third reading, a process that was experienced as fluent with no particular challenges. Each transcript was coded from beginning to end before coding the next interview while highlighting significant statements, sentences, or quotes that articulate what participants experienced and how they experienced it. Codes were then clustered into categories, which were later clustered into themes (Moustakas, 1994) and organized in a hierarchical model using the MAXQDA visual tools. The process of clustering and categorizing codes into themes, while conducted out of an effort to maintain the connection to the essence of participants' original statements, involved what Colaizzi (1978) called “a precarious leap” (p. 59), as our subjective creative insight and interpretation of participants' interviews played a crucial role in the data analysis. The process ended with 39 final codes, out of which 7 for the substances each participant reported using (Table 2), 11 for integration practices (Table 3); 19 are described in detail in the results section; 9 were excluded since they were used to code less than ten text segments in total (Humor, Ineffability, Creativity, Disintegration, Dreams, Reincarnation, Being, Becoming, and Transcendence) and 16 additional ones were excluded since the scope of this analysis did not allow to relate to all specific aspects of participants' psychedelic experiences (Fig. A5).
Summary of substances participants used
Substance/Name | Greta | Timothy | Sarah | Jane | Laura | Robert | Isaac | Alfred |
Psilocybin | X | X | X | X | X | X | X | |
LSD | X | X | X | X | X | X | ||
MDMA | X | X | X | X | X | X | X | |
Ayahuasca | X | X | X | X | X | |||
Peyote | X | X | ||||||
DMT | X | |||||||
Ketamine | X |
Note. The table represents the substances that each participant described an experience with during the interview and not necessarily the total sum of substances taken by the participants.
Summary of integration practices
Practice/Name | Greta | Timothy | Sarah | Jane | Laura | Robert | Isaac | Alfred |
Peer Support (M) | X | X | X | X | X | X | X | X |
Yoga (M) | X | X | X | X | X | X | X | X |
Meditation (M) | X | X | X | X | X | X | ||
Journaling | X | X | X | X | X | |||
Therapy | X | X | X | X | ||||
Time in Nature | X | X | X | X | ||||
Engaging with Symbols/Archetypes | X | X | X | |||||
Singing | X | X | X | |||||
Painting/Drawing | X | X | ||||||
Dancing | X | X | ||||||
Playing Music | X |
Note. Practices are ordered by a descending order according to the number of participants that reported them. (M) signifies a major code.
Results
Themes and codes
Data analysis of participants' interviews lead to five core themes: Psychospiritual Development, Ontological Changes (fundamental shifts in one's understanding and perception of the nature of reality, self, and consciousness), Assimilation into Personal Life, Integration Practices and Assimilation into the Clinic. The latter started as a code and was later defined as a separate theme out of our will to distinguish between one's personal and professional development and between aspects of psychedelic meta-integration that relate only to mental health professionals and those that relate to all people. Since it is beyond the scope of this article to present each theme and code, we will briefly present all the themes that emerged from data analysis and some of the codes that are most relevant to transformations participants experienced with regards to their clinical practice, as this paper focuses on the particular theme of Assimilation into the Clinic.
For explanations on the reorganization of codes into the hierarchical code model, see Appendix 2 and Figs A1–5.
Theme 1: Psychospiritual Development
This theme delineates the various methods through which psychedelic experiences and their subsequent integration processes support psychological and spiritual growth. It encompasses five codes: Interpersonal Development, Emerging from a Crisis, Emotional Development, Psychic Constructs and Love. Following is brief elaboration of the code Psychospiritual Development (that became an overarching theme during data analysis), as well of Interpersonal Development and Emerging from a Crisis:
Psychospiritual Development
This code describes participants' personal psychological and spiritual development process. They all described their psychedelic experiences as integral to their development and growth and as experiences that shaped their perspectives and understanding of life. They also found it difficult to separate the impact of psychedelics from their psychotherapeutic processes and lifelong spiritual practices like Yoga and meditation, as all of them contributed to increased insight. As one participant said: “psychedelic experiences are part of my development, part of how I grew up as a person”. Another participant said that her psychedelic experiences allowed her “to be more vulnerable and authentic with [her]self first of all, and then it allowed [her] to be in touch with the fact that it’s the most important thing to [her]”. A third participant explained “[He] can no longer write off behaviors as habits and now all of these things that are habits are choices that [he makes] and [he understands] the implications of those choices”. A fourth participant emphasized that “… you have to understand where you are going, like to be ready to change […] like if you want or you are ready to take a responsibility to change your life”. A fifth participant said: “I don't think I could be who I am now without them”, while a sixth participant went as far as saying: “I feel that in a way, everything that unfolded in my life is a result of this very simple vision of having a safe glimpse into infinity”.
Interpersonal Development
This code includes participants' descriptions of changes in their relationships with other people. One participant described he is much more open to hear other people's opinions and experiences, another shared: “I'm a better listener, I'm better being-a-friend, being-with”. A third participant emphasized that after his psychedelic experiences he better understood the “the amount of candidness, and also courage that is needed for communication to be truly open”. Contrary to other participants, one participant got further away from other people, and said: “I really had no one to process these experiences so I became very reclusive for many years […] it was like kind of separation between me and the world.”
Emerging from a Crisis
In this code participants describe mental-emotional crises they went through and things they feel they gained as a result. One participant went through a psychotic episode that took place after she took psilocybin mushrooms “several times in a row”, during a period where she was under a lot of stress as she was going through a divorce and had teeth problems. It ended in a psychiatric hospital. She said that this experience “was something that changed [her] forever” and described feeling “deep thankfulness” for the way this experience ended and for the opportunity to be lifted out of this situation and for “be[ing] whole again”. Another participant physically struggled with the shaman who lead the ceremony. He said he was “depressed for a few weeks afterwards” and added he eventually grew from the crisis as he allowed himself to receive support from his family, friends and teachers.
Theme 2: Ontological Changes
Participants described a variety of ontological changes that took place as a result of their relationship with psychedelics. The codes of this theme that were identified are Spirituality (Meaning, Connectedness, Centeredness, Spiritual Guidance and Oneness), Not Knowing, Reality, and Death as a Part of Life. In contrast to the previous theme that started as a code and became an overarching theme only later in the coding process, Ontological Change is a theme that was created only at the end of the coding process after clustering the codes described above. It is important to notice that the paragraphs and phrases that were categorized under this theme relate to long-lasting changes in the existential modes of participants. Following is a brief elaboration on the code “Not Knowing”:
Not Knowing
Participants describe a humble approach towards people and life's events through an embracement of the sense of “not knowing”. One participant said he stopped dismissing people's opinions as weird or crazy, and said that he is “much more able to be empathetic of states of being and consciousness that [he hasn't] experienced yet just because [he] understood that there is so much that [he does] not know”, and added: “the more that I will learn, the more I will find out that I do not know”. Another participant related to her newly integrated sense of not knowing through the psychotic state she was in after a psychedelic experience: “Knowing is crazy. The crazy people know. I knew, I knew during my terrible process, I knew everything for sure […] Not knowing is for me to be sane.” When asked about how did his psychedelic experiences affect his practice as a therapist, a third participant replied: “although paradoxically I think I know more today, I have less to do with thinking about me knowing more and someone else knowing less”.
Theme 3: Assimilation into Personal Life
Participants described a multitude of ways by which they bring their psychedelic experiences and insights into their personal lives. This theme includes the codes: Letting go, Acceptance, Nature, Somatic Experience and Family. Following is a brief elaboration of the original code “Assimilation into Personal Life” together with the first three codes:
Assimilation into Personal Life
This code relates to general daily transformations that occurred in participants' daily life as a result of their psychedelic experiences and insights. One participant said her psychedelic experiences gave her “joy of life” and that she is a “happier person”. Another said that her psychedelic experiences increased her sensitivity and that she is more creative, with singing and painting being a meaningful part of her life now. A third one assimilated his psychedelic experiences into daily life by being “here and now” and by taking better care of his health by practicing yoga, by eating better, and by quitting medications, cannabis and tobacco. A fourth participant said that psychedelics increased his capacity to love and feel loved, increased his sense of trust in himself, supported him in establishing a lasting sense of acceptance and gratitude, and that as a therapist he senses that the quality of his heart was widened.
Letting Go
This code relates to participants' ability to- and experience of letting go in their everyday life. One participant described how her psychedelic experiences taught her to let go of behavioral patterns she was used to. Another described how his psychedelic experiences allowed him to let go of a limiting core belief that he is “not able to experience life fully”. A third one said that she learned that when she lets go, “everything is alright”. A fourth participant shared a realization he had about the importance of “los[ing] something from you in order to gain something”.
Acceptance
This code includes participants' testimonies, where they describe shifts in their sense of acceptance throughout their everyday life. One participant described how her psychedelic experiences brought her to accept a wider range of behaviors and things that can be normal for other people. A second participant described that he is less categorical in his thinking and that he can now accept different states within himself and accept his loved ones “for who they are”, without judgment. Another added that her psychedelic experiences helped her to be more kind, and described a sense of acceptance of things as they are, especially with regard to her parents. A fourth participant said that he is “less critical, less spiteful, more accepting, more forgiving but not in a way that becomes an excuse for doing anything that's wrong just as a way of maintaining inner peace”. A sixth participant said he experienced “a radical acceptance state of mind”, where he can accept “the most anxiogenic thoughts and ideas”.
Nature
In this code participants mention shifts with regards to their relationship and appreciation to nature. One participant explained that being in nature supports her in regulating and discharging the “energy that goes through [her]”, a second participant shared how environmental issues became very important to her and added: “after you see that everything is one, you bring it wherever you go”. Another participant said that psychedelics “… evoked the understanding of the importance of nature in the life of human beings and this motivation to go back to nature [him]self, and to basically sometimes prescribe, quote unquote, more time in nature to [his] patients”. He also mentioned he uses more metaphors from the natural world throughout sessions in the clinic. A fourth participant said: “Nature is not part of my life but my life. I am much more in touch with animals, much more in touch with trees and rocks and mountains…” and emphasized she brings it into practice by having “an ecological way of living”.
Theme 4: Integration practices
Participants described a wide range of practices that help them implement their psychedelic insights into their daily lives. Among them, all mentioned the immense importance of peer support in the integration process. The practices participants used to support their psychedelic integration process are summarized in Table 3.
Theme 5: Assimilation into the Clinic
While all five themes together relate to the psychedelic meta-integration process in the lives of Western mental health practitioners, this particular theme is the main focus of the paper. Participants detailed both the diverse ways in which psychedelics and the integration process have contributed to their professional development as mental health professionals, and their altered perspectives on mental health broadly.
One participant noted a significant change in her perception of mental crises following her psychedelic experiences, stating she gained insight into “what it feels like when things are falling apart….”. She added that the spiritual dimension is “a part of everything [she does]” and that she discusses spiritual matters in the clinic only with patients who are seeking to talk about it. Another participant said: “… through working with myself with anxiety or with my semi-psychotic experiences under psychedelics, the way I see the people in front of me in the clinic naturally changes”. She also mentioned psychedelic experiences that transformed her approach to abandonment issues, and her understanding of psychodynamic processes. She shared an experience where she “initiated [her]self with love”, something that taught her an important lesson of not having to do “the initiations rough and hard”, an insight she carries to her clinic and shares with her patients. A third participant described how her psychedelic experiences changed the way she brings herself into her clinical work: “I'm a better… passenger when I'm listening. I'm willing to live my own world totally and to go where the person takes me. I'm not afraid of losing control, in the room, and in general. OK, let's lose control, and not understand nothing and ask a lot of questions so I can see really good what he is trying to show me”. She added that she “opened much more as a person for what can be normal and OK for somebody else” and that she is “hunting” for symbols during her work as she “believe[s] a huge amount of what is happening is not seen on the surface”. She concluded by saying: “I'm not trying to take anyone to any place anymore. The situation itself takes him. I believe in the process”. A fourth participant explained that his psychedelic experiences “improved greatly” his empathy, his “ability to be with other people in whatever they are feeling” and to “reach in within [him]self to find an experience that is similar to whatever they are experiencing in order to relate”. These also allowed him to approach patients “with much more eye level manner” and helped him realize that sometimes rather than trying to solve issues, allowing things “to manifest by their own nature, is exactly what is needed from a professional in this field”. After realizing that there is “so much that [he does] not know and so much that is impossible of grasping”, he feels that he also reminds his patients that “it is OK not to know […] that compassion and patience are very important in dealing with issues, not only for a person to other people but also every person to themselves…”. He does not write off his patients “colorful and unique delusions” as “crazy beliefs” and recognizes that his experiences “evoked the understanding of the importance of nature in the life of human beings”, something that he now brings to his practice as a psychiatrist both by recommending them to spend more time in nature and by using “metaphors from the natural world or the animal world”. Similarly, a fifth participant explained his experiences “instilled in him a great sense of humility towards all aspects of the human experience” and that they provided him an “awareness training” on how to “…to just sit back and be very curious and respectful towards people's experiences without judging, and as little as possible analyzing and interpreting. more learning how to trust the process, go with the flow…”. He added: “I confess that I find myself these days a bit impatient towards the mainstream dynamic psychology when it itself is impatient to other things”. A sixth participant said that the big change that happened to her professional practice during the last years might not just be because she works on the spiritual dimension of her patients' lives, but also because she is “getting the intelligence of the tools that I have to work with also through my own connection to the universe, so it's not just me and my client, it's me and my client and the universe working with us”. A seventh participant said that as a therapist, he has “way greater acceptance of people where they are” and that he has more patience for longer processes and for hindrances and blocks during the therapeutic process. Similarly to others, he described having “more acceptance and openness regarding other ways of people to view the world” and shared he intends to be “less interpretive, less directive, and more focused about what in [his] presence allows the patient to heal himself”. The eighth participant described that his “heart was widened” and that his capacity to love was enhanced towards himself as well as towards his patients. He said that his “intuition is stronger, and [he sees] the healthy part of a person in front of [him] easily and put that as the main thing”. He also recognized how by having less criticism towards his patients, he establishes “much better doctor patient relationship” and emphasized that traditional psychological theories have “a lack of focus in that spiritual aspect of the human being which [he finds] is very important”.
Discussion
From the interviews, it became evident that there is a need to acknowledge the cumulative impact of all psychedelic experiences and their integration processes on an individual's life. This realization prompted us to coin the term Psychedelic Meta-Integration. This process is supported by a variety of practices that enable the integration of diverse aspects of the psychedelic experience into an ordinary state of consciousness, and help maintain a connection and a sense of continuity with the most significant lessons of the experience. It encompasses transformations across personal, professional, and transpersonal realms, contributing to psychospiritual growth and ongoing pursuit of wholeness. In this context, we discuss the major findings concerning the relationship between personal psychedelic experiences and their relevance to clinical practice.
The personality traits of mental health professionals are reflected in their clinical practice through the therapeutic alliance they establish with their patients (Ackerman & Hilsenroth, 2001, 2003; Chapman, Talbot, Tatman, & Britton, 2009), their conceptions of mental health and societal norms (Stuber, Rocha, Christian, & Link, 2014) and, as this study suggests, through their “way of being” in the clinic. All participants described a process of Psychospiritual Development, where their psychedelic experiences supported them in becoming who they are today and in fostering vulnerability, authenticity, and a sense of responsibility for their lives. Seven out of eight participants reported an Interpersonal Development that took place as a result of their meta-integration process, the core aspects of it being an increased sense of openness, compassion, and humility which participants could bring not only to their communication with friends and family but also to their professional practice, where these qualities serve them in being more attuned to the unique gifts and challenges each individual brings to the therapeutic process. Their experience of Emerging from a Crisis increased their ability to relate to their patients' experience of psychological and spiritual crises and to have a better grasp of what it means to emerge from such experiences toward healing and growth. This experience also enabled them to better support similar processes when encountered in the clinic and to establish a better therapist-patient relationship. Some codes of Assimilation into Personal Life also relate to their professional practice, for example, the way they bring Nature into their work by recommending their patients to spend more time in nature or by using metaphors from the animal world to convey the nature of different processes and situations. Participants' intention to leave their world outside the clinic and to accompany their patients wherever they want to go in their journey of self-exploration, reflects an essence of Letting Go which they bring not only to their personal life but to their clinic as well. Also, Acceptance was reported in relation to their therapeutic practice, describing more acceptance towards different behaviors, different states of consciousness and as a general sense of being less judgmental and accepting things as they are. Naturally, the Ontological Changes they went through are also reflected in their clinical practice. They all described an integration of the spiritual dimension into their life, and thus a lens through which they view not only their own experiences but the ones of their patients as well. The integration of a humble Not Knowing stance allowed participants to be more empathetic towards states of consciousness they have not personally experienced, as they recognize the vastness of what remains unknown. This ontological shift away from the certainty of knowing enabled them to relate to their patients' experiences with greater openness and acceptance, fostering a more compassionate and non-judgmental therapeutic approach.
The results of this study indicate that the psychedelic meta-integration process encompasses a broad range of enduring changes in the lives of mental health professionals. These changes extend to their patients, influenced by the therapists' ontological stance regarding their professional role and life in general. This influence manifests in the quality of the therapeutic alliance, in the therapists' recognition of various extreme states as elements of the patient's healthy functioning and in an overall increased openness to the spiritual dimension of life in the psychotherapeutic process. Participants view psychotherapy as a holistic endeavor that must address the interconnectedness of body, mind, and spirit, rather than focusing narrowly on mental processes alone. While still valuing the insights of traditional psychological theories, several participants express frustration with the constraints of the dominant paradigm, particularly its tendency to pathologize or dismiss unconventional experiences and its lack of emphasis on the spiritual dimension of human nature. Essentially, participants describe a shift towards a more non-directive, patient-centered approach, and report a heightened appreciation for the potential of non-ordinary states of consciousness in bettering their clinical practice.
Limitations
For the majority of participants, differentiating the impact of their psychedelic experiences from that of their overall therapeutic and growth process proved challenging, as both occurred concurrently and addressed similar issues. Additionally, given the phenomenological retrospective design of our study, the specific selection of the study population, its size, and the lack of a control group, we recommend that our findings be interpreted with caution and humility. Future research employing a more rigorous methodology is essential to comprehensively understand the influence of psychedelic integration and meta-integration on clinical practice.
Conclusions and future directions
Our study points towards a lasting and positive effect of psychedelic meta-integration on the practice of mental health clinicians, corroborating Rajcok's doctoral thesis (2022) on the enhancement of empathy, compassion and understanding among clinicians through psychedelic experiences. The exploration of how personal psychedelic experiences influence the professional conduct of mental health experts is a critical area for further study. This is especially relevant for clinicians in the field of psychedelics, as their profound understanding and ability to express complex psychological experiences make them invaluable for examining the extensive impact of psychedelics on human cognition and behavior. Mental health professionals with personal psychedelic experiences possess a distinctive perspective on the psychological dynamics of these substances. Their insights are crucial in shaping effective treatment methodologies and guiding future research endeavors. Moreover, their firsthand knowledge is instrumental in assessing both the therapeutic potential and the risks associated with psychedelic use. This unique standpoint is vital for the evolving discourse on psychedelic-assisted therapies and the broader understanding of their role in mental health care.
As suggested by our study, a significant outcome for Western mental health professionals with multiple psychedelic experiences could be the development of an open, humble, and compassionate approach towards others and life's varied phenomena. Investigating the role of psychedelic integration and meta-integration in human development could be useful in addressing the current global mental health crisis and potentially trigger a paradigm shift. This shift would acknowledge the importance of concepts such as meaning, faith, belief in higher powers, altered states of consciousness, and comprehensive bio-psycho-socio-spiritual crisis intervention models in psychiatry. In the context of clinical practice, such paradigm shift may lead to a more inclusive, flexible, and evolving approach to psychotherapy that keeps pace with the changing needs of individuals and society, recognizing various extreme states as elements of the patient's healthy functioning.
Future research could explore the long-term effects of psychedelic integration models on well-being, comparing groups with and without structured integration protocols. Additionally, examining the impact of repeated psychedelic use on therapists' compassion, perhaps through a longitudinal study involving control groups engaged in compassion-cultivation practices like meditation, would be valuable. Employing fMRI to validate findings in relation to the neural correlates of compassion (Engström & Söderfeldt, 2010; Immordino-Yang, McColl, Damasio, & Damasio, 2009) could further substantiate these insights. Further studies might also assess the influence of psychedelic integration on forming strong therapeutic alliances from both patient and therapist perspectives. The multidimensional effects of psychedelic meta-integration offer a unique lens through which we can explore fundamental aspects of humanity, our connection to the sacred, living purposefully, and engaging with existential questions, all while fostering compassion towards ourselves, others, and the planet.
Authors' contribution
This study and its analysis were designed and conducted by N.T. The manuscript was drafted by D.H., N.T., and G.S. All authors contributed to interpreting and writing the study results and revised and approved the manuscript for intellectual content.
Acknowledgment
Our deep gratitude goes to Dr. Michal Stein for her extensive support with the MAXQDA program and to the participants of this study who openly shared with us their personal journeys.
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Appendix 1 - Interview Questionnaire
Pre-Experience Phase
- •Why did you start taking psychedelics?
- •How did you prepare for the experience, if you did?
The Experience
- •How would you describe the psychedelic state in general?
- •Did you experience any challenges during the experience, if so, could you describe them?
- •Can you please describe to me the most meaningful moments/insights you had during a psychedelic experience?
Post-Experience Phase
Personal
- •Did these experiences change your self-image? (If so, how?)
- •How did you assimilate these experiences to your daily life?
- •How long did it take for you to take a psychedelic again, if you did, and why?
- •Did you experience any change in thought process after the experience?
- •Did you experience any long-lasting emotional change?
- •Did your psychedelic experiences change the things that are meaningful to you?
Spiritual
- •How did it affect your understanding and experience of spirituality?
Interpersonal
- •How do you share these insights with your surroundings?
- •Did it have an impact on your interpersonal relationships?
- •Would you recommend this to other people?
Therapeutic
- •How did these experiences impact your practice as a therapist?
- •Did these experiences change your understanding of traditional psychological theories, trauma and mental health in general?
Appendix 2 - Hierarchical code model
While codes could be re-organized in a variety of ways, the hierarchical code model (Fig. A1) was constructed out of an effort to convey the main domain of impact participants described in the context of the different codes, and thus serves the articulation of the multilayered transformation the psychedelic meta-integration facilitates. As the results of this study (as well as the available literature) suggest, the psychedelic integration process is one by which people engage with the multidimensional content that was produced during the psychedelic experience so it could be assimilated into one's personal life. Since this was a major focus of the interviews, Assimilation into Personal Life was used to code the largest amount of data, thus being the most prevalent code (Figs A2 and A3). As can be seen in the Major Code Intersection Model (Fig. A4), Assimilation into Personal Life intersects (used together with other codes to code a specific text segment) with 11 other major codes, which emphasizes not only the close and intricate relationship the texts behind these codes share, but also the central part this code play in participants' experience of psychedelic integration and meta-integration. The numerous intersections emphasize the core aspects of life that took part in the assimilation process as well as the different processes to which the assimilation process contributed to. Interestingly, Family came forward as the code that was most intersected with Assimilation into Personal Life (Fig. A4), which highlights the important role family life play in participants' assimilation and integration processes. Similar diagrams could be produced for additional codes and for specific participants, representing a further level of analysis and a way to penetrate further into the inter-dynamics of the different codes and the inner-dynamics of individuals.
Hierarchical code model
Note. Code map of the psychedelic meta-integration process, created by the author on the MAXQDA program.
Citation: Journal of Psychedelic Studies 2025; 10.1556/2054.2024.00372
Major codes
Note. Codes that appeared in the transcripts of at least 75% of participants (6 out of 8).
Citation: Journal of Psychedelic Studies 2025; 10.1556/2054.2024.00372
Proportion of coded segments of major codes
Note. Proportions of coded text segments of major codes (Fig. 2) represent the amount of text that was coded with each code. The order of the code names in the legend on the right, correlates to the descending counterclockwise order of the chart (starting at Assimilation to Personal Life – 16.9%).
Citation: Journal of Psychedelic Studies 2025; 10.1556/2054.2024.00372
Major code intersection model
Note. Code intersections occur when a specific text segment is coded with more than one code. Codes that intersected less than four times were excluded from the model. The numbers on the connecting lines (as well as line width) represent the amount of times both codes were used on the same text segment. Code colors represent the different themes as shown in the hierarchical code model (Fig. 1). Themes were located on the central horizontal line.
Citation: Journal of Psychedelic Studies 2025; 10.1556/2054.2024.00372
Hierarchical code model excluded from in-depth analysis
Note. A section of the hierarchical code model that was excluded from in-depth analysis, created by the author on the MAXQDA program.
Citation: Journal of Psychedelic Studies 2025; 10.1556/2054.2024.00372