Curating An Optimal Psychedelic Experience

Podcast Highlights

• A therapist's perspective on the usefulness of psychedelic therapy
• The limits of preparation and the importance of self-reflection
• How best to handle "bad trips"

Show Links

1. Support us on Patreon
2. Sign up to our Microdosing Course
3. Synthesis psychedelic retreats

Podcast Transcript

0:00:28 Paul Austin: Hey listeners and welcome back to The Third Wave Podcast. I'm your host, Paul Austin and we have another Third Wave Node Event for you on our podcast day we recorded this at the end of November, November 29 in New York City as part of our third wave event series there. It's with Dr. Elizabeth Nielson and Dr. Ingmar Gorman who both work for the Center for Optimal Living. Both of them have been on clinical trials and the focus of this conversation is around curating an optimal psychedelic experience. We go ahead and chat for about an hour with 30 minutes of Q&A. Ingmar and Elizabeth both bring their expertise from a more clinical, harm reduction perspective whereas in much of this podcast, I speak about our experience running retreats at Synthesis and what role Synthesis has played in helping us to understand how to facilitate optimal psychedelic experiences for people who want to have this highly meaningful, transformative experience.

0:01:30 PA: Again, this is part of our Third Wave Node Event series which is our initiative to bring in-person community to cities all across the world. We started with events in New York in San Francisco, which we are now doing monthly, and we hope to expand to Vancouver, LA and Austin by the end of 2019. When it comes to supporting us with the podcast just a brief couple of things, A, we'd really appreciate your support by going to patreon.com/thethirdwave and there you will find our Patreon page where you can donate to support our page and our project. The other way to support us is if you're interested in legally working with psychedelics, we are now... I co-founded a retreat center in Amsterdam called Synthesis, where you can legally work with psilocybin. Again, you'll hear more about that in this podcast. And if you sign up for Synthesis Retreat through Third Wave, you can go... That effort goes towards supporting us here at Third Wave. So without further ado, I bring you Dr. Ingmar Gorman and Dr. Elizabeth Nielson.

[music]

0:02:47 PA: So really the focus for our event tonight is about curating an optimal psychedelic experience. So as many of us know, having gone through or at least read about psychedelic experiences in the past, there's a significant difference between just taking some mushrooms for the hell of taking some mushrooms and actually doing work with psilocybin in an intentional framework. So, what we really wanna dig in tonight is, what is that difference and what creates that difference between just taking a bunch of psychedelics and having a trip, and actually having a transformative meaningful experience that can lead to significant positive changes in the long run. And what we're going to focus on is we're going to focus on first preparation. So how do we prepare for a psychedelic experience?

0:03:37 PA: Then we'll talk about the actual experience, the ceremony, how do we set up the ideal container for transformation, and then finally, how do we begin to integrate that experience over the long term, and what are practices that we can use, what are things that we need to be mindful of after we've had a peak or transcendent experience. And to dig further into that topic, I've brought on and invited Dr. Ingmar Gorman and Dr. Elizabeth Nielson. Let's go ahead and go right into the interview. I wanna introduce Dr. Ingmar Gorman and Dr. Elizabeth Nielson who are psychedelic therapists and clinicians. And I won't go too much further into details, I'll allow them to explain a little bit more about what they do. So, if you could please give them a warm round of applause.

[applause]

0:04:35 Ingmar Gorman: Thank you so much for inviting us to this. I'm very excited to be here and thank you all of you for being here. I will introduce myself. I'll go into some of my roles, some of the things that I do, and it's kind of important because I guess you could imagine the different responsibilities that Elizabeth and I have is sort of like a Venn diagram, and there's some overlap, obviously, things that are related to psychedelics, but we work with psychedelics or psychedelic experiences in two different contexts. So, first of all, I'm a psychologist, I am the co-clinical or co-principal investigator on a study of MDMA-assisted psychotherapy for post-traumatic stress disorder which is funded by the organization MAPS which is the Multi-disciplinary Association for Psychedelic Studies. A non-profit that really has made the world that we live in today in terms of the progression of psychedelic science possible. MAPS really owes... We owe them a lot of credit. So I direct with a colleague of mine, Casey Paleos a site where we actually prep people, we administer MDMA, we do integration with them, and the indication is PTSD.

0:05:51 IG: So these participants have PTSD. Now, another role that I have is as the director of the psychedelic Education and Continuing Care program, and that's in a center called the Center for Optimal Living. Now that's a private practice site. So just like you would go to psychotherapy, you see a therapist at a private practice. Now, what that means is that because psychedelics and MDMA are not legal, we do not administer any psychedelics there, but we do it something that we call psychedelic harm reduction and integration and we'll be spending more of today, really talking about that, I think is gonna be the focus of it. But we may be bringing in our knowledge and experience from both of these realms to have this conversation. I'm also a post-doc at NYU at the School of Nursing, there's a behavioral science training program there.

0:06:48 IG: So I'm a therapist. I work with individuals. And another thing that we really focus on in the Psychedelic Education and Continuing Care Program, the Psychedelic Program for short, is education. The education piece is really, really important to us because we... There are not enough of us. There are very few practitioners, therapists, mental health professionals who are equipped to work with people who have psychedelics. Not just administering psychedelics, but just being able to listen, provide support, understand what some of the risks might be. And so what we do is we do every few months now, we do workshops where mental health professionals come in and we do two-day trainings, where our objective is to help equip these people to be able to help others and we could talk a little bit more about that, too. Yeah.

0:07:41 Elizabeth Nielson: Okay, so as Ingmar said, my name's Elizabeth Nielson. I'm also a psychologist. Are there any other clinicians in the audience aside from the one that I already know about? Yeah, a couple. Okay, great. One of my key interests has been in training of clinicians and how clinicians get comfortable with new sets of skills and new practices and new types of empirically supported treatments, especially in the world of addiction treatment. And I'll give a little bit of my story. So about almost five years ago now, I was finishing my dissertation on that topic, or something related to that topic, and I was asked to consider becoming a therapist on the study of psilocybin-assisted treatment for alcohol use disorder, which I accepted and took up and continued to pursue for long enough that it actually started to happen, which was a long time. It was a lot of meetings and a lot of waiting in the world of research.

0:08:35 EN: But my background and interest was always in empirically supported treatments for substance use of all kinds, be it addictive or problematic or just for fun or for whatever other reason people may use substances. I was trained in a harm reduction approach and the harm reduction approach is really about enhancing autonomy and helping people make self-actualizing and responsible decisions, providing information, enhancing safety, providing health care, right? It's about treating people with compassion and respect no matter what they choose to do.

0:09:14 EN: A couple of years later, when I was figuring out what else I might be doing with my professional life and I came across the Psychedelic Program, which is part of the Center for Optimal Living, which is a larger psychotherapy practice focused on a harm reduction approach, it was a very, very natural fit for me. Ingmar was already part of that program. It had been founded by himself, Katherine MacLean and Andrew Tatarsky several years prior. So coming from a background of both harm reduction psychotherapy, harm reduction as an approach to working with substance use as well as psychedelic-assisted therapy being an emerging, new potentially going to make the grade as an empirically supported treatment for alcohol use and other addiction problems was a very, very natural fit for me, so that's how I ended up being part of that. And then, of course, by extension here.

0:10:07 EN: So again, like Ingmar, I wear two different hats. I do a lot of work as a clinician on psychedelic-assisted treatment studies both with psilocybin and with MDMA, various sites and places, but that's a large portion of my work and then at the Psychedelic Program, work to provide both individual and group psychotherapy that can include harm reduction and integration work around psychedelic use, as well as lead trainings for clinicians who are curious about this topic and wanna learn more.

0:10:43 PA: So let's kind of transition into the subject of the night. I'll just start this quite broadly, quite open-ended. And like I mentioned before, we're really gonna focus on preparation, the actual ceremony and then integration. So if we could just start on a high level, what does preparation mean when it comes to a psychedelic experience?

0:11:05 IG: That is, yeah, quite a high level. So this is where it helps to, and I'll probably be referring to this quite a bit, delineating between are we talking about a clinical study or are we talking about the harm reduction integration work that we do in private practice, right? So, I guess on a very, very high level, preparation... Well, in a clinical study, the person is there to receive a treatment to get a psychedelic. And so, that, if they've gotten to the point where they've been evaluated and screened where they would be appropriate for that kind of experience, the preparation will look one way, but in terms of the work in the private practice, the preparation will, may even include or I think primarily is about developing the person's autonomy to make a decision on their own. So in other words, we are not telling them, "Taking psilocybin would be great. A great idea for you." That's not our position. It would be an evaluation on for the person to make their own decision about what they think is best. And so we might be talking about, "Okay, well, what are some of the pros and cons about using psilocybin at home on your own or at a retreat or with an underground therapist, if that's what they're considering?"

0:12:24 IG: We're helping them think through what all the implications of that might be. That may be the very first point of preparation, whereas in preparation in a clinical trial, the first thing that comes to my mind really is about developing a relationship and there's maybe some overlap there, too. So the connection that we have, that the fact that the person who we're working with in either context, that they feel safe with us or there's a beginning of a development of a safe relationship is absolutely 100% key.

0:12:46 PA: And why is that? Why is that ability to be safe, that ability to be vulnerable so important when it comes to this experience?

0:13:05 IG: There are many answers to that question, but foremost, the ability for the person who's going to be undergoing an experience to be able to remain open. To be able to remain open to the experience that comes for them and if there is any kind of difficulty that arises in the experience or after, they trust that they can tell us about what is coming up for them because there can be a lot of shame around sharing that kind of deep internal experience.

0:13:39 EN: Yeah, I would just add that in our private work, we're in a very neutral position in some regards. We're not gonna actually be with people who are... During their experience but for them to know, if they're coming to us for help preparing for an experience and for them to know that they have someone that they can come back to and talk to about their experience that is going to meet them with an attitude of curiosity and kindness and non-judgmental open awareness, perhaps somebody who's heard experiences, heard about experiences like this before and can help normalize it in a certain way, that can allow the person to just feel more comfortable, can reduce anxiety. It can reduce the tendency to maybe push certain states or experiences away.

0:14:36 EN: So again, as clinicians, we realize that not all clinicians are comfortable having that conversation with a client who may be saying, "You know what, I think I'm gonna go to Peru next month and drink some ayahuasca. What do you think?" There may be clinicians who find that anxiety provoking because lack of familiarity with it, unsure what to expect, is this gonna... How is this gonna work? What's gonna happen? May have heard very few stories or only really sensationalized stories. So, being able to just hold that space for somebody and help them consider it in a balanced way really invites more conversation about it and I think reduces the isolation that can occur around it.

0:15:18 PA: And let's dig into that a little bit more from a user perspective, the harm reduction integration perspective. Let's say someone comes to you and they want to attend an ayahuasca retreat either in a legal country like Brazil. Obviously, there are many circles that are going on in places like Upstate New York. How would you... What process would you walk them potentially through so that they're as prepared as possible to go into a psychedelic experience?

0:15:45 EN: Well, the first thing we wanna check out with somebody is what have they already found out, what do they already know, how have they educated themselves, what is their existing relationship to ayahuasca and to this idea of going to do ayahuasca. So, people, sometimes, they'll say, "What's your relationship to this as you're coming in? I don't have one yet, I haven't tried it yet." But you do have a relationship to it, you heard something about it that's made you wanna do it. What is that thing? What's the idea? What are you seeking? Is there some deep unmet need that you think this is going to meet? That's what I wanna know about is there, maybe there's some social pressure to try it. Maybe there's some kind of stigma about being the last one of your friends who hasn't. So, those are the kinds of things that I wanna find out.

0:16:38 EN: So it's not just about like, "Well, have you heard this and have you heard that and do you understand what it does pharmacologically?" But what's your actual relationship to it, where are you starting from, where are you building towards and then how might that relationship evolve as you start to look into centers, as you start to educate yourself more. We will talk about balanced decision-making, weighing risks, benefits. There are some wonderful harm reduction guides and guidelines for safer practices and guidelines for safety measures. And there's just a ton of information out there that people can check out and look at. But I think the first thing I wanna know is what is their relationship to it? Why and what are they actually seeking?

0:17:18 IG: We can dig into that a little bit deeper. One is, a question I like to ask is, what would it look like if your planned experience went well? That's connected to this idea of what you want to get out of it. I think one thing that we pay a lot of attention to on our end is the language that people use. So, are they saying plant medicine? Are they saying... What is the culture that they are immersed in? I've worked with people from Santo Daime and that's a particular kind of culture. So, that's a real... So, what I guess I'm speaking to a little bit is... It's from a user's perspective but again, from ours, which is an assessment, evaluation, we're interested in knowing how are you functioning, how potentially... We know that what we think... Psychedelic experiences can be healing but they can also be incredibly destabilizing. So, what kind of support system do you have, people around you who can help you if things go a little awry for, say, a brief period of time? There are all sorts of questions that we think about and we ask so that, really, fundamentally, safety can be maintained.

0:18:48 PA: And one thing that keeps coming back to me when it comes to the preparation process is how Stan Grof will often refer to psychedelics as non-specific amplifiers. And so this is often a practice that we will use with the retreats that we're running in Amsterdam is having people journal before they come in, having them answer and write out a few questions that really start this method of self-inquiry. Meditation is one form of self-inquiry. You can go deeper into things like breath work. But if you haven't started to tread those waters, so to say, then if you're jumping right in with a high dose psychedelic experience, it can often be quite jarring. Are there specific exercises or things that you'll walk people through from a preparation perspective to open that basement of the unconscious, so that way, when they really go in there in a high dose psychedelic experience, it's not totally like, "What is this? What's going on?"

0:19:43 EN: I always ask people what other practices they have for accessing alternative states of consciousness, what methods have they tried, what methods have worked for them, what do they like, what do they not like, how is that going for you. I think it's really dangerous to pin everything on psychedelic experience as the only possible method for accessing an alternative state of consciousness because even with... Given the research, and let's say, everything is as successful and pans out the way that we imagine that it may, there will still be people for whom psychedelics are not appropriate. And there are still other amazing methods for accessing alternative states of consciousness, having insights, experiencing oneself in different ways. And I think that knowing... For someone to know that they have the power to access those things maybe feeling differently but in a different way can really help take some of the anxiety out of it and some of the pressure off. So we'll pretty much always talk about that and I do think that's also helpful... Those are helpful tools for being able to sometimes navigate what could be intense overwhelming emotional experiences during the psychedelic experience but it works both ways.

0:21:01 IG: Being in touch with breath, I think that's something that we really, really encourage in preparation for something that could be potentially intense. And also, there are a lot of contradictions I think in this work and one of them is I don't want to be misunderstood. I think that what you have people do is totally positive, completely positive, but also we are... I also am very attuned to, what is the person doing when they come in to see me? What are they like? Some people [chuckle] are very... They can be very organized, maybe very neurotic, and there's people I've worked with who are about, "Okay, let's put down the research," They've read everything, [laughter] like preparation maybe for one person, a little bit letting go and loosening to the experience, rather for somebody else, it may be more like, "Okay, let's have you go through some exercises or write down some things that you... " Intention is key, there's no about it but there's these flavors that we also can work with.

0:22:12 PA: Yeah, I mean, this is something that I'm totally guilty of in terms of the over-reading or the over-immersion and then in the thinking side of things, listening to podcasts and other things, and this is what I notice as well with a lot of retreat participants who have come to synthesis, especially lately. Most of them read Michael Pollan's book, and that's even interesting how the language that Michael Pollan used about the default mode network and about dissolving the ego and about all these things is now becoming the proto-linguistic way that everyone is now talking about psychedelic experience, when in fact, there are obviously many other ways to describe the process of what's going on.

0:22:56 PA: And the mind, in some way, is much more, like you said, organized, and when we start to go into the body, when we start to experience both, especially for me, at least with psilocybin, it's often very shadowy side, so shame, anger, sadness, fear that come up that's very messy in a way. And this, I think transitions, or at least I'd like to transition this to then the actual space and ceremony, and not necessarily from your personal work but just from a general perspective, what is... If someone is going to work with psychedelics and we could talk both from a clinical perspective and also from a more general perspective so whether that's retreats or at home. What's a great way to set up a safe environment that is inviting to dig deeper into one's own psyche?

0:24:00 IG: As I'm listening to you, I know we're transitioning... It seems like we're transitioning from the prep a little bit to the experience itself, and there's something that I wanted to share before we do that, which is, what Elizabeth and I do if somebody comes into our session saying, or into our private practice, saying that they intend on having a psychedelic experience, and as I've already emphasized we kind of, it's about empowering the individual to make their own decision, but I want to state this explicitly that we don't refer people to underground therapy. We don't refer people to retreats either, and we certainly don't do psychedelics with them. I mean, you'd be surprised how often and how insistent people can be when we tell them that we don't administer psychedelics in our private practice or we don't, or, "Please don't come in on LSD," and they all... And they think that...

0:25:09 PA: Have you had that happen in the past?

0:25:11 IG: It hasn't happened but people, we've told them multiple times, and then they'll still think like, "Oh yeah, I get it, I get it," like do we get better. So you want me to come in and like, "No, no, no, please don't," don't do that. I just wanna really make that clear and maybe I don't know, Elizabeth, you might have some more to add but I think the big picture reason, well, why, why don't we refer to underground therapists, why don't we refer to retreats? And mainly, it's about empowerment but it's also about for me, maybe, or I'm sure for Elizabeth as well, there's an added element of not being sure about what happens at these retreats, there not really being a licensing process or oversight. And again, this is not to undermine in any way what you do, I'm not coming across in that way. I think there are ways that these things can co-exist but in, us as licensed professionals, we have certain standards of ethics that we have to follow in order to do what we do in a above ground way.

0:26:17 EN: Yeah, thank you for that. We can and do help people find information about getting into studies, which are legally available, FDA Approved Studies that are happening in New York and in other places as well. But right no, we, MDMA or psilocybin are not available as treatments and that may again change in the next year or two or three hopefully. So it would be beyond our scope to recommend that as a treatment, mental health treatment or something like that. But we also I think we're in a unique position because we maintain our mentality in part because we're not providing that option to people. So people aren't coming in for a consultation about a session that we offer. They're coming in for to help with the decision-making process around something they may or may not do somewhere else, and that's basically how it breaks down. About the actual, I want to move to your actual comment about the actual setting.

0:27:22 EN: Well, all I can say a little bit about the setting in the clinical world, there's a standard procedures, standard operating procedures that are fairly consistent across most studies. A little bit of variation here and there, but fairly consistently, you see something that looks like a living room type setting, a couch, a couple of table lamps, a few nice pieces of art work, maybe a gong, some flowers, music, two nice chairs for therapists. These setups look a little bit different, but they tend to be fairly consistent across most settings, and the participants in studies will be lying on a couch, on their back or however they choose to curl up, and they'll have eye shades and headphones. They'll be able to listen to music throughout the day and be encouraged to have an inner-directed experience, where they're focusing more on their internal experience and therapists are there to support if and when needed. And that's a standard idea that's been replicated across a lot of studies now and the idea is to promote an inner experience that is going to be unique.

0:28:39 EN: So it's not so much about trying to engage with the environment or trying to have therapy during the actual experience, although before and after, there can definitely be plenty of conversation. What happens for people in other settings, I think, is gonna be unique to the person in the setting and what's best for them and establishing safety is going to be... Have to be individualized. What's safe and appropriate for one person may not be exactly the same thing that's safe and appropriate for the next person. That's really something that we take on an individual basis, I think, with certain standard... Certain things that we look for.

0:29:21 IG: So you mentioned personal, so maybe I could say something personal. So, MAPS gives their therapists the opportunity to have their own MDMA experience with two therapists present to understand what it's like to go through that trial with that therapy, in a way. And one thing that I remember clearly from that experience was, again, coming back to that sense of safety, that I didn't have to worry about the quality of the drug, I didn't have to... If something were to happen to me, physically, medically, I know that there was an MD present. It really allowed me to let go and have the experience. Music is important and one thing that is consistent across all of the research is having music without words because that can prime you or lead you to think or feel a certain thing, not that that's necessarily entirely bad, but it's more of a projective process, and a person will very much connect to just the tone of the music and the dynamics of the music. I think that just being comfortable is really important, so just paying attention to where you'll be sitting, where you'll be laying. And on a maybe, I'm gonna go on a limb, and maybe get myself a little bit in trouble here, but...

[background conversation]

0:30:57 IG: Great. Yeah, I know this is what you're hoping for. You started in the beginning, you had mentioned in your introduction like it's one thing to take psychedelics, just for... Or mushrooms, and to take mushrooms... For mushroom's sake, is another thing to do, to take mushrooms to do work. And I, in a very conservative way, want to say that it can also be about play. So I think there is a lot of... There is a particular emphasis on like, "Okay, I'm gonna go and have my healing experience and it's gonna be, you know," [laughter] I don't know I'm gonna go through the mud and sometimes that's what it is, but certainly, I think people report really beautiful, positive, beneficial experiences that are full of joy and laughter. And I really want to make sure that that's also not lost in the experience.

0:31:51 PA: And oftentimes, experiences will have all of that.

0:31:54 IG: That's true.

0:31:55 PA: In one.

0:31:56 IG: Yeah.

0:31:56 PA: And then it's also, it sometimes has to do with the substance as well. And again, just speaking from personal experience, with LSD, I found LSD to be much more playful and open. With psilocybin, and I found it to be much darker, but then I drank Ayahuasca, and I heard all the shit, about purging and how terrible it was, and then it was this really sweet, loving, really nurturing experience that was completely antithetical to everything that I had heard. This is where it is then, and one thing to emphasize with this entire evening is curating your own psychedelic experience is... It's literally about that. It's going to be extremely personalized to you, your space, your energy, your intention, who you are, because ultimately, the beautiful thing about the psychedelic experience is shutting all the layers of distraction that we deal with on a daily and weekly and monthly basis and actually getting to the root of who it is that we are.

0:33:02 IG: I think another thing that's kind of overlooked is, there's setting and then a friend of mine came up with the word, cast, like the cast of characters. So who are you doing it with? And so, if you're talking about non-specific amplifiers, what we see in the... Certainly, what we see in the clinical trials is an amplification of what we call transference, in other... Maybe put it simply, sort of the dynamics, the things that are kind of coming up in the relationship between two people, or say, the person who's on the psychedelic and then say the person who's sitting for them. And so, I think this is something that's kind of overlooked in a way like, who are you doing the psychedelic with, and how are they going to relate to you while you're in this alternate state? Are they going to join you in that experience?

0:33:57 IG: Well, they're a part of it, no matter what, but are they going to try to get you to feel a certain way or can they simply just sort of be a calm presence for you? Or do you wanna go and have fun with them? And I don't know, like frolic in the fields or whatever, it's sort of... But it's something to really think deeply about like who are... What are you going to... Who are you doing that with or do you trust them? Because that's something that we also see in the integration work that we do. Sometimes people have a negative experience, or are feeling quite anxious or have a really hard time after, because the person they did the experience with abandoned them or couldn't be with them in the intensity of the state that they were in.

0:34:48 EN: Yeah, I think that the relational safety is a really important thing to think about, especially when there's people who have an existing relationship, maybe difficult relationship, maybe there's some baggage there. And when you're... In the studies, when you are working with somebody who's therapist, that therapist is there to be your therapist. You don't have to worry about the relationship with them in the same way that you do if you're doing this with a friend or even somebody who's a paid guide or in a different relationship to you, a volunteer or something like that. The relationship is different and this is also really... So what we do is harm reduction integration therapists, we're there to be the therapist and to support the person in their autonomous decision making. They don't have to take care of us by making a decision one way or another, right. So that's a really important thing to think about as far as the relational piece.

0:35:50 PA: And I wanna add one more thing about the group dynamics, and this is really, I think, critical for what you mentioned in first of all I'm just doing this with friends or people that you know. There will likely be some strengthening or could be some strengthening of bonds. So that's something to be mindful of, that if you're doing this with friends, I personally would... I personally do withhold from doing it with people that I'm just getting to know, for example, because to go into that deep vulnerable space with people who you don't really know well yet could put you in a place at the end result that you don't really wanna be in. I think the second thing to add to that is because retreats are becoming more popular, and because they're now in many ways the most accessible legal way to do psychedelics, whether that's ayahuasca in South America or truffles in the Netherlands, it's also important to ask, who are going to be these retreat participants who may join you when you're going on a retreat? Because you're going to share one of the most vulnerable, potentially vulnerable experiences that you'll ever have.

0:36:54 PA: So that's something to be mindful of when you're applying to retreat, is just asking those questions to the people who are hosting. What type of people do you attract? What background do they come from? Why are they attending? So, last piece is integration and I think this is really the most important piece, is after we've had a peak transcendent experience, what do we do to then integrate that on an ongoing basis? So I'd love to just start at the high level again, just by talking about what is integration?

0:37:31 EN: So when I hear the word integration, I think of applying the insights or experiences to the larger scope of one's life. So that might mean for instance, having an insight about something that you've been fearful of for a really long time, and no longer maybe feeling so much fear around it. But then applying that and actually going out and engaging with that thing differently in a behavioral way in your relationships, in your work environment, in whatever else it is that you do in the rest of your life. I think integration can... It's often used to refer to a very short term, sometimes, group process that'll happen at the end of... After an experience at a retreat or maybe for a few weeks afterwards and then it will be... People will refer to an integration circle or something like that, and those experiences can be valuable for sharing one's experience for connecting with others around it for getting support, for identifying areas of problem that need to be maybe further developed or further attended to. But actually integrating an experience, it can be a many years long process and we see it on a continuum.

0:38:46 EN: So from this very short term, like getting out of retreat mode, beginning to eat meals and sleep and take care of oneself and return to a state of non-alternative state of consciousness and go to work again the next day but it can also be a much longer term process as well, and it can be supported by things like other methods of yoga, meditation, breath work, non-psychedelic but other methods for access. And it can also be supported by psychotherapy, by peer group support, by online community, by coming... By events like this that are connecting with other people around the same topic things like that. So there's a wide variety of things it involves.

0:39:33 IG: Prolonging benefits and also reducing or minimizing the harms or the negative consequences to thought... Ideas that we use a lot in the research and also in our work with the integration work is, one is that sometimes it gets worse before it gets better. And this is connected to an idea of how do these psychedelics, how do they create change, what did they do? One idea that I'm pretty fond of is that it can grant people access to thoughts and feelings that were otherwise pushed away. And there's this state of being open and reconnecting to those, and that reconnection that lasts longer than the pharmacological action of the drug. And so that may be that state of things getting worse before they get better, and often people reach out to us at that point. The sad thing about that is that they're maybe feeling more anxious or suicidal or depressed. The sad thing about it is that people think that they've... This is not like ABC or something, they fucked up their brains. I can say that right?

0:40:39 PA: You can, you can...

0:40:41 IG: I hope we don't get YouTube demonetized or anything like that.

0:40:44 PA: No, we might get an explicit on iTunes.

0:40:46 IG: You can bleep me up. I say that because that's the word that they use. I wanna emphasize really the intensity that they've learned from drug education that you fry your brain and they're really worried that that's what they've done when in fact that's actually not necessarily the case. Maybe they're just feeling a lot of stuff that they haven't felt for a long time and we talk to them about just that idea and that can reduce anxiety around the integration process. And then sort of figuring out, "Okay, what now that you're feeling these things, what does that mean?" And if somebody has been through a history of abuse and trauma from say, even a young age, that's not gonna wrap up in three integration sessions. Integration to me isn't so much about, "Oh, I had this fantastical, spectacle of an experience where I saw the like the... I don't know, unfolding four-dimensional dragons through time or whatever or self-dribbling basketballs or it's... " And how do you make sense of that? It's much more about like, "Oh, this has opened up all of these aspects of a person's life and now it's kind of going into making that less almost... I'm thinking about spiny or something that sort of hurts and something that can actually be lived with." And depending on who you are and what your experience have been, that can last a varying amounts of time. And that to me is really what integration is.

0:42:14 PA: So let's get a little bit deeper into that and talk a little bit about the difference between clinical and the work that you do at the psychedelic program. What might be differences in how you approach integration from someone who's dealing with PTSD for example, compared to someone who's just had a high dose ayahuasca journey is now going back to talk about how things might work out.

0:42:37 IG: Well, they may not look all that different in terms of the integration process. In fact, I like to sometimes say for clinicians who are really eager to do psychedelic therapy, being the ones that give the psychedelics, I find it almost like the integration work outside of the clinical setting where you're giving it, meaning the integration work in the private practice. That is almost, if not just as gratifying 'cause that's where the work is really happening. So there's a lot of parallels to it. This is not what you mean, but I mean maybe... The first thing that came to my mind about the differences is that in the clinical trial, you actually end treatment after a specific amount of time.

0:43:16 IG: Generally, the model is that you have your last dosing session and then you have three integration sessions then you're done. And that can be really heart breaking for both us and the participant because we have to end our relationship. Whereas in the work that we do in private practice as long as that person feels like they're benefiting and they wanna work with us that can continue. And for people who've had particularly trauma in their interpersonal relationships where a sense of finding somebody safe and that they could trust in and grow with, that's really important. So I know that that wasn't necessarily the intent of your question, but that's like one big difference.

0:43:51 EN: Yeah, I think the response of the mental health field is really important and that's partly why we do what we do and work as we do to help not just to train clinicians but to make sure that there are programs out there that are offering trainings for clinicians that provide continuing education credits. So you can actually get a certificate on your wall that says I have completed approved training in Psychedelic Integration Therapy. Because just the fact that somebody can come into a psychotherapist office and talk about these experiences and go home with a bill they can send to their insurance company, that is legitimizing and reassuring. And I think that in itself reduces the stigma around it and the scariness around it and there are many people who may not have someone that they can talk to that will offer them that space and not judge them if they go to their doctor, they go to a therapist, who's unfamiliar with this work.

0:44:54 EN: I'm not saying judgmental, but just unfamiliar with it. They may inadvertently just reinforce that anxiety. Somebody comes back on Peru and they're all shaken up and they go to their therapist who's not familiar with this stuff, and they say, "I'm all shaken up." And the therapist goes, "Uh-oh, what did you do? I don't know anything about this. I gotta Google it." That might increase anxiety. So just by being there and being aware of this stuff, educated about it, giving people places they can go. The fact that we have a website, people can look it up and say, yes, there is a legitimate topic to go and talk about, that right in itself, I think it helps reduce anxiety and make that integration a little bit more possible.

0:45:31 EN: Another thing I wanted to mention is that often times some people are going on retreat to Peru in the ayahuasca circles, they're being exposed to incredibly different culture, setting and world view, and the shamanic frame, the shamanic world view, the ideas that come with that, the whole way of interpreting reality and the world are completely different. Almost completely different from our normal daily world of New York. So that alone can be a shock to people's system coming back from that. It could be a shock even if you went to the jungle and spent a week in a shamanic retreat center and didn't drink any ayahuasca to come back to Manhattan after that.

0:46:17 EN: It should be a shock. So, just even helping people settle into understanding there's somewhat of a normal re-entry process and that there's... We're trained to be able to assess for when we should be really concerned about somebody and to assess for safety and help do safety planning, and help make note of basic functioning, and is this person really in danger, what are things they can do to help themselves feel more grounded, get more grounded and all of that. But just understanding that process is really important so as not to exacerbate it, I think.

0:46:52 IG: I feel there's also attention here between us giving tips versus explaining what we do. They're the two agendas here, and I'm not sure the audience, what they're here, what you want to get from this, but on the sort of topic of tips...

0:47:08 PA: Tips are good.

0:47:09 IG: Tips are good.

0:47:09 PA: Tips are good.

0:47:11 IG: And this is gonna be very high level and maybe not that helpful. A participant once asked Bill Richards about how do they sustain the benefits of what they gained from their psilocybin experience, and Bill Richards says, said something like, "Do anything that you can." So that's that answer.

0:47:29 PA: Or take more, take more psilocybin.

0:47:29 IG: I don't know if that messes up the other.

0:47:33 PA: The other one?

0:47:35 IG: That's another topic that we could talk about, taking more. Well, the other the thing I wanna say was that, we were at Horizons once, and we were talking about integration and Bia Labache, I mention this a lot, I really... In a friendly kind of way. I was pretty offended by something she said in response to our talk which was like as therapists, or talking about psychedelic integration, it's all about talk, talk, talk, talk, talk, and that's what she said. And I was like, "Well, what do you mean? That's what we do." And I had to digest that for a while, and that's all that we've been really... That's a lot of what we've been talking about today here, if you have a psychedelic experience, and then you come to us and then we help you by talking about it. And I take Bia's point to heart which is that sometimes it's not about talking and when you have your experience and you're done with it, you may feel inspired to tell everybody about what you learned, your insights and there can be a benefit in not sharing it.

0:48:36 IG: So holding that to yourself. Of course, there's a judgment that has to be made there, but sometimes maybe, when you speak something, it transforms and changes and then maybe you're tied, then you find yourself being tied to the thing that you verbalized, rather than allowing it to digest a little bit. And I'm also saying this to say that not everybody needs to see a psychedelic integration therapist. We are here for certain situations and for certain people and certain cases. I certainly don't want to say that, you have a psychedelic experience, then you have to come and see us. I don't, that's not the case. You can, I think people can have this... Do this on your own, but I also like to think about benefit maximization and maybe a way to maximize the experience is to see somebody like us.

0:49:23 PA: Yeah, work with someone, or... 'Cause there's a certain element that relies on the self. I think this is at least something I've learned from psychedelics is we as individuals, have a lot of autonomy. And I think that's a big part in many ways of the personal transformation is realizing that we, and in ourselves, are very capable of healing.

0:49:43 IG: Essential piece is this idea of the inner healing intelligence. And if you haven't, or the intuition, put plainly. If you haven't... If you aren't familiar with this idea, this is the one thing that you should take from this talk which is that... And this is true across the board, whether we're working in the trials, or whether we're working in private practice, really supporting the person's intuition about what is right for them in terms of their process of healing, and us really not getting in the way of that, of their intuition. And that's what we think psychedelics maybe in part do amplify that sense of where a person, their values and maybe where they should be heading in their life.

0:50:23 PA: So on the topic of doing more psychedelics. So if someone goes and has a big psychedelic experience... I think this is my rationale for microdosing, I think sometimes, I'm like, "Well, then we can just... You know." So, and before I dive into that, I'll briefly describe a metaphor that we teach at some of the integration workshops that we do at Synthesis which is this metaphor of going to the dentist. And so every six months, you go and see the dentist, and they obviously give you a deep clean. At least I think most of us.

0:51:01 IG: Some nitrous oxide, right?

0:51:01 PA: Most of us, right, nitrous oxide is well, that's always nice. So every six months, you go into the dentist and get a deep clean but every day, you brush your teeth and you floss. And so the way that we try to contextualize that for people who are coming to do retreats, is every six months, can be healing to have a peak experience. So, that doesn't necessarily mean just psychedelics, it can mean going and spending a weekend in the woods, it can mean going to something like Burning Man. There are various other peak experiences, and then every day, in terms of cultivating a practice of connection, things like meditation, spending time outside, breathwork, those can all help to facilitate that awareness on a day-to-day basis.

0:51:44 PA: Now, this isn't obviously a hard and fast rule for everyone, but this is somewhat the framework that we try to help contextualize. So A, what are your thoughts on that framework, but then B, when is it appropriate if someone's had a high-dose psychedelic experience to say, "Okay, I feel comfortable now and I could maybe go do another one." 'Cause there are some people who, for example, will drink ayahuasca many, many, many times, thinking that the answers will continue to be there when in fact there's just... You gotta pull out and sort things out.

0:52:12 EN: I think, first of all, I think my dentist would definitely approve your analogy. [laughter] Probably appreciate it very much. I think it's individual, and I think it's gonna be different for different people. And this is where I tend to be a little bit wary of anything that sounds like, "Here's how you should do it. And here's the prescription, and this is the rhythm. And this is the amount." And I think this is where we come in and try to really reinforce and hold and help people with making their own decisions, their own autonomous decisions, and say, "Well what do you feel is right for you?" And that is going to be different for everyone. There are segments of the psychedelic... Broader psychedelic community I guess I would say, that you have certain standards or expectations about how often these things should happen, how much it should be, that value certain types of experiences over others, be they peak experiences or microdose experiences, while shying away from one or the other.

0:53:20 EN: And within some circles that can be very, I don't want to say rigid but a really strong expectation of following certain norms around that. Norms, I guess is a better word it, societal norms. Well, so for instance, let's say somebody goes on retreat and they're going on an ayahuasca retreat, and they're gonna be there for 14 days, and they're gonna have eight ayahuasca ceremonies. Some retreat centers are flexible about that and will say, "You're welcome to come and not drink one night, if you feel you've had enough." Or, "You're welcome to sit with us in ceremony one night just to see how it feels before you try it." Or have a sort of flexibility around that. And maybe in other places there's a strong, more of a rule that, "This is what you signed up for. This is what you're going to do." And I've heard reports of both from people that I work with. And I tend to think that enhancing personal autonomy and decision-making is always gonna be important. It should always be the person's decision what they're doing.

0:54:21 EN: And there can also be within some circles an idea that if there are any problems arising, the answer is more psychedelics. The answers is to drink more ayahuasca, take more mushrooms, have a higher dose, have more experiences, and I don't think that's necessarily... It maybe true for some people and in some cases, but for some people it's important to take break, digest some things, work through some things, let things settle down a little bit, and time can really be healing at that point.

0:54:51 PA: Yeah. And we've seen this somewhat with the rise of 5-MeO-DMT. The popularity of 5-MeO-DMT is, psilocybin is one level, then you have ayahuasca on the next level. And then it was like, "Oh no. Now, we can definitely go higher than that." because 5-MeO-DMT is, if done properly, will put you into complete white light and dissolve any sort of ego or boundaries. Michael Pollan wrote about it in his most recent book and said it was a very harrowing experience. And I think this is part of as more and more people become interested in it, it's like how can we keep leveling up, so to say. It's almost like a competitive ego trip in itself.

[laughter]

0:55:30 PA: In some ways. I really wanna dissolve my ego, so I'm gonna just see how much I can go into it.

0:55:40 IG: I'm very wary of the different psychedelics or different levels. Just the idea that there are different levels. There's so much to say here. One thing is, I'm bringing it back. One is, maybe we will be able to know something more certain when it comes to certain pathologies. So I'm not talking about general well-being, but maybe a certain number of psilocybin experiences at a certain dose is, if we do enough studies, and then we'll be able to say.

0:56:10 PA: Because with some of the very initial preliminary studies that they've done on, I believe treatment-resistant depression for psilocybin, it seems like for some of the people the benefits start to wane after six months. That's a larger issue that we won't really cover tonight, that has to do more with the social environment that we cultivate ourselves, that I think is bringing that back on. But that's another discussion.

0:56:35 IG: Maybe just to make another point which is this idea of returning to the medicine. There are particular cultures or religions that... And I would imagine that that even varies from place to place, but that emphasize regular, say, ayahuasca use. And there are people who, both in North America and South America, who've used ayahuasca once a month for years. And I'm not judging that but I've also... I've worked with somebody who after a great period of time got stuck in their experience or in their... They got stuck. And they kept going back. And the experience didn't change and they went back and back for I don't know a year or two. And then the first thing that our work was about was, "Okay. Well, what if you did not do ayahuasca for a month? And see how that goes."

0:57:29 IG: And then there's this other issue that I know that Elizabeth has already spoken about, but the idea when people are in a really very, very, very difficult destabilized place, and then the answer is, "Return to the medicine." So to speak. And that I find very frightening because I think the intention behind it is, "Oh, they haven't had the breakthrough yet. And once they have the breakthrough, the destabilization or symptoms will go away." It's an interesting empirical question, but that just seems to be a fairly risky kind of thing to do.

0:58:00 EN: Yeah. And I do wanna add to that just in terms of translating the research and trying to interpret it in ways that might be helpful to people using psychedelics in other contexts. We really can't do that part and parcel, and just say, "Oh well, this is... Well, the outcomes people got in the research after one dose of psilocybin, or two doses of psilocybin. So I'll try it in this other context and expect the same thing." Can't do that for a whole host of reasons, that is a very dangerous type of translation to try to make. However, it may be helpful to keep in mind that by and large the research studies that have been done have been done with two, maybe three doses, and then follow-up after that. There is research on people who are regular users of ayahuasca and their safety, and their health conditions, and their overall long-term relationships to drugs and alcohol use, problematic drug and alcohol use, which is more naturalistic observational research. But the clinical studies are usually one dose, two doses, maybe three.

0:59:07 PA: Because we have about five minutes left before we transition into Q&A, if we could just summarize everything that we spoke about in five minutes. When it comes to prep, ceremony integration, how would you describe an ideal process?

0:59:25 EN: I would summarize it in just a couple of key words that I think about through the whole process. One of which is safety, not just physical but psychological, relational, legal... Safety in all ways, I think is very important. Personal responsibility and autonomy. So you're on autonomous decision making, taking responsibility for that decision and being a participant in the process as opposed to having that autonomy removed is super important.

1:00:03 IG: This is rather than having different ideas or processes, rather we can... We're completing for each other.

1:00:07 PA: Collaboration.

1:00:08 IG: Collaboration. Yeah. So the first... For prep, it's preparing for the expected and the unexpected. Meaning really the idea to stay open to whatever may come. And somebody who I worked with recently really did a exemplary job of doing that. He had a very specific intentions he wanted to... Specific benefits he wanted to get from the experience, but he really embraced this idea of whatever my experience will be, that's what it will be. And it absolutely worked for him to have that stance to his experience. The actual ceremony, I don't really have much to add there, I think just re-emphasizing safety being really key.

1:00:54 IG: And then integration, one thing we haven't really said is that, what is integration? What does it mean? It means to make whole. And that can mean different things for different people. Jung talked about integration as sort of... Or analysts may talk about as integration of bringing the unconscious to the conscious. But if we talk about it just more generally, it's seeking wholeness. And so integration, in my mind, whether it is related to a psychedelic experience or not, is about having a sense of what it feels to be whole and then doing the things in one's life to get there. And that can mean things like meditation and different skills and practices, but it can also mean connecting to community. And I think that that's something that we really lack in this country.

1:01:45 PA: Well, thank you so much for all your insights.

[applause]

1:01:55 Speaker 4: My question is around how you can utilize music to influence the experience. I know majority of our... The experience itself is largely uncontrollable, but we can guide it through intention, set and setting and all that fun stuff. But in terms of using music in a clinical setting, I'm assuming that's something big. To what degree can you use the music to influence a certain level of suggestibility to the tripper? And secondly, is there ever a situation in a clinical setting where you guys don't use music?

1:02:34 IG: Yes. So I would... One thing I... I think that music may be one of the variables that we are not really giving enough attention to. So all of the trials have music. The psilocybin trials, Heffter trails, they're a little bit more consistent with the music that they play, whereas the MAPS trials, it's really up to the therapist team to come up with their own music set list. So there's incredible amounts of variability there. And we really don't know to what degree music is a factor in, say, outcome. Now, to speak to the MDMA study, I really like this idea in terms of structuring the music over time. And this applies... Well, it would apply to psychedelics as well, but particularly with MDMA, it is partly an amphetamine. And so as the MDMA, or any psychedelic, really coming up, people feel weird and they feel maybe there's a little bit of anxiety there.

1:03:35 IG: And so the music is structured in a way where the first, say, 90 minutes is really more soothing and calming and that is to just allow a person to relax into that experience. But after the 90-minute mark, we're not really interested, particularly in terms of treating trauma, or I think really for anything. We don't want a person to just be relaxing the entire time. And so we transition into what we call more activating music or evocative... I like that word even better. Yeah.

[laughter]

1:04:07 IG: Evocative. And that's, again, up to each therapist. The way that I like to have the music there is that sometimes it can be... Sometimes it's sad, sometimes it's epic, something that would encourage. It can be classical, it can be all sorts of genres of music. I don't stick to any particular one. But it also... And it changes and shifts over time. So the idea is that we're evoking different kinds of emotional states and memories and thoughts. And then somewhere around the five-hour mark or six-hour mark, depending on where a person is at in their experience, because we may also change the music depending on what we're seeing the person is doing or what they want. They may wanna stay in the sort of evocative place. But the last portion of it will be what we call the integration period, where it's not... I don't know how I would describe it. It's not necessarily calming and relaxing, but it's not as intense as something that is evocative. It's more, I think of it as maybe a little bit more playful and maybe supportive.

1:05:16 EN: Yeah. So people can have all kinds of different reactions to the music that's played. And I think those can be actually a great place to enquire about reactions and interpretations. When you play the same playlist for a whole lot of people having psilocybin experiences, you really get to see how varied reactions can be to the same piece. And that's something coming from within the person that they're putting on it, so it's a nice thing to be able to ask about. That being said, if somebody's having a really difficult reaction to a certain piece of music, and I think in any setting to push that on somebody would probably not be advised. You wanna balance the evocative music, or music that could sort of be heightening emotion with music that is not going to perhaps unnecessarily push somebody in a direction that's really problematic.

1:06:14 EN: And again, that's something that's gonna be individual in the moment kind of decision making and reading what's going on with that person. And then in other settings, music and if you think about festival settings, rave settings, party settings, music is often mixed in the moment in response to... Usually not just one person's experience, but the entire crowd's experience. That can be one way of thinking about it. Certainly in shamanic settings music is made organically on the spot in response to what the individuals are experiencing on an individual and group basis. So there are several different intuitive models from that. And then what's happening in the studies pulls from that, but it's a much more canned and controlled interpretation of it.

1:06:57 IG: I just wanna also add that if a participant doesn't want the music to be on, we turn it off. So it's also this idea of the intuition or inner healer listening to what the person needs. And if it's distracting for them or difficult for them, then the music doesn't have to be on. Jumping back to something that we... I don't know if we even really made explicit here, but we really haven't spoken about going inward. I think that's implied in retreats that people lie down and they have an internal experience, but I think it's important to designate. Some people may think that you take a psychedelic and then you do stuff or you talk to your friend or whatever. But there's a whole world inside. So just to put that idea out there. One way to have this experience is to have somebody and this is what we do in the trials. We're there to sit and observe while a person has an internal journey.

1:07:58 PA: And a couple of more tips on that. There's a couple really good playlists on SoundCloud that are open source and available. Some of which were put together by a scientist named Mendel Kaelen and it's an Imperial College sound track. It's the one that we've worked from at Synthesis. And Mendel is also in the process of raising funding and developing an app that uses bio-sensors to create algorithmic music for psychedelic therapy and it's called Wavepaths, and I think he's releasing the app. It's not gonna be soon but it will be in the future at some point. And there will be music from Brian Eno and John Hopkins and Greg Haines and a number of other well-known ambient and acoustic musicians. So those are things to look forward to.

1:08:50 Speaker 5: Can you talk a little bit about your experience with any highly negative experiences on an individual level and maybe in group.

1:09:02 EN: Is there more to that question? Is there like a question behind the question?

1:09:05 S5: Just what you've encountered and how you dealt with those encounters, individually and in groups.

1:09:14 EN: In our work in the psychedelic program, so sometimes people may come to us after having had a bad experience, and how...

1:09:22 S5: Well, I'm talking more about like in... Because they're coming to you and also they're dosing while they're with you, correct?

1:09:28 EN: No.

1:09:29 S5: Oh.

1:09:31 EN: In the research studies they are, but if we're talking about our work at the psychedelic program, we're seeing people for usually post-experience integration work.

1:09:42 S5: I see. No wonder my question is confusing.

1:09:44 EN: Yeah. [chuckle] That's okay.

1:09:46 IG: You can answer the question either way, just we just need to know in what context you mean. When we're with somebody or when we're helping them after?

1:09:53 S5: Well, I really meant... I was under the impression that people were seeing you and they were actually dosing and going, and you were upholding space for them. So I thought you...

1:10:04 EN: We are, but only in research studies.

1:10:07 S5: Okay.

1:10:07 EN: So that's gonna be a very limited context. So if you're curious about how we might interact with somebody who's having a difficult experience at a festival or something like that.

1:10:17 S5: Yes.

1:10:17 EN: That... Okay.

1:10:18 S5: Okay, yeah. You can talk about that.

1:10:20 EN: Okay, we can talk about that. Except that's not... That's also not what we do. But we can talk about that.

[laughter]

1:10:27 EN: Obviously, people go to all kinds of different settings. We've talked about a lot about retreat settings, maybe we can talk a little bit more about festival settings. Festivals, Burning Man, music festivals, other places, a lot of them now have harm reduction, psychedelic harm reduction groups, entities that are part of the structure of those festivals working at them, and providing on-site psychedelic harm reduction work. So maybe I can talk a little bit about what that is and why, how it's different from the other things we've talked about, 'cause we haven't touched on it. A couple of the organizations that I'm aware of that are doing that are groups like Dance Safe, the Full Circle Tea House, the Women's Visionary Congress, as well as MAPS Zendo project, anybody heard of Zendo. Yeah, okay. Great. So Zendo, I can maybe just touch on a little bit more.

1:11:18 EN: They are trained people to provide peer support at festivals and they go and set up a tent and people who are having difficult experiences can go to that place and someone will sit with them and see them through that experience. And Zendo offers trainings for people who wanna do that work and then volunteer their time at festivals. This is not something that I've done, it's something that I've heard about from people that I know who have done it. And Ingmar has done it, so he can talk more about it. But that work is not... It's not providing psychedelic therapy.

1:11:50 EN: It's seeing somebody through what maybe a difficult experience and reducing the possibility of harm of them potentially harming themselves, harming someone else around them or just generally becoming more traumatized perhaps because they got into more of a difficult situation because they became disoriented, whatever happened, or the people around them didn't know what was going on. So the idea is that they're in a safe place and they're being watched over and cared for and seen through the experience. But they're not being engaged with in... As though they were in therapy, and that's, I think, a really important distinction for that particular work. In our work at the psychedelic program, we're not with people when they're having their experience. We're helping them work through the after effects, aftermath of it. And sometimes, those experiences are difficult experiences. Somebody comes back and they wanna talk about it, but then we are actually doing therapy around working through that difficult experience, if that makes a good distinction. Do you want to talk about Zendo?

1:12:49 IG: I'll just jump off from where you left off. Because I think you may be interested in like, what is it that... What are the kinds of things that we do? So, one this is again, helpful tips or general ways to think about it. One, so with the work that we do in the MDMA, or that I do in the MDMA trial, where I'm with somebody after I've given them MDMA, and they begin to have a difficult time, like they begin to say, have something like a bad trip, if you would call it that. One key piece is for them to not try to control it, and for them to... We really encourage them to go into the difficult, we encourage them to go into it. Allow it to happen, see if they can, in a way, accept what is happening, to essentially not push or resist it too much. And we're there, again, this idea of safety, so they know that we're there, we're on their side, we're there to support them. Now switching gears to the work that we do in the psychedelic program where say somebody comes to us and they say, "Well, last month I did ayahuasca, I had a terrifying time and now I'm feeling anxious and depressed." And all sorts of different permutations with things that can happen.

1:14:00 IG: One tool that I use is to help the person understand what is the significance of that for... What is the meaning of that experience for them? And I'll illustrate it with an example of somebody who I worked with, who I treated, who's given me permission to talk about this, and this is like a very, very, very brief version of it, which is, in her ayahuasca experience in Peru, she thought that... She heard this voice, and the voice kept saying, "You're stupid, you're stupid, you're stupid, you're stupid," over and over and over again, for, I don't know, five or six hours. And that left her suicidal and with a lot of anxiety and depression, and she reached out to me for help. And this is a total over-simplification, 'cause I'm giving a very brief part of it, but a key piece of it was for her to realize that she was so self-critical, like we talk... Going back to the non-specific amplifier, that's what it did, it amplified that inner critic of hers and it just would not let her go.

1:14:56 IG: And she really wasn't aware of how much social anxiety she had in her life and how self-critical she was and how she thought everybody was constantly critiquing her. And so for her to just... One piece of it, was, oh, her realization, "Oh my gosh, that's what happened. That's the significance of that experience. And maybe I don't have to be so critical of myself." And it's more complex and it took more time than just that one switch, but that was sort of the seed of something. And so, there can be great value in these experiences that can be really disturbing.

1:15:34 Speaker 6: So, my question kind of builds off the bad trip thing. More in terms of, you brought up the dark side of psilocybin earlier, which we were talking about actually on the car ride in, especially compared to LSD and kinda forces you to confront, I guess, negative or repressed or I guess the shadow part of your personality. My question is, how do you, one, recognize that that's going on and then, two, integrating those things that you learn about yourself, or those repressed, maybe it's aggression or whatever it might be and bringing that to light as, I guess, this is kind of like a yin yang question, but definitely things that I've experienced, had been very difficult for me and sort of self-actualizing, something like that.

1:16:21 PA: So the first thing that comes to mind is what you mentioned about how integration represents wholeness. So I think that is often the perspective that, I, at least, will take is that there's no good without bad. And that there's no light without dark. It's just the dualistic nature of the world that we live in. So I think coming to that recognition and understanding, that allows us not... Instead of acting with judgment about, "Oh, I feel this way, and it's bad," it's just, it is. And I think that allows some of the pressure or kind of shame that might come from that to dissolve. So that would be part of my take.

1:17:01 IG: That's a great attitude, absolutely, to have that. If you can do that all the time, like that's...

1:17:07 PA: Yeah, yeah, yeah, it's not...

1:17:07 IG: I still like... I think that's what I'm working towards. The other thing to recognize in that question though, is that we have... The reason why the shadow exists, if we wanna use that language is, or the reason why we are a particular way, is because we adapted to be that way. There are certain situations that we were in over time that made us who we are and so there's... We come to a point in our life where we realize, "Oh, there's some ways that we kind of are that." Sometimes, somebody uses the word super power. We've got really strong in this one aspect of how we are, because we've practiced it a lot, but then that's created a shadow and we're in a place where we're weaker. And so, just to understand that, I think that just is a really important understanding to, in a way, to have self-compassion for yourself. Because we could be picking at the shadow for maybe forever, I don't know if that ever gets, anybody ever becomes perfect.

1:18:00 IG: Another way of getting at that question is, and I think this is what sometimes can be really beautiful about non-ordinary states or these experiences is, again, this idea that it unfolds over time that you can have insight into your shadow walking down the street. It's something that is totally ordinary if you just sort of pay attention to it and you're reflecting and thinking about how you are in the world, and so that's a... It's an ongoing process that will probably go on forever and you'll get better and better and better over time.

1:18:31 EN: I think this is one of the most important places where being able to connect with others and hear other people's experiences is, because it's one thing to realize that you have a shadow and difficult things going on in your mind and your experience and suffering and struggling, and pain and strife and mental suffering going on and it's another very powerful thing sometimes to sit in a roomful of people and realize actually everyone does. And when I think about I think a lot of... I draw heavily on my training in meditation and my teaching in... Teaching others meditation trainings and there's a reason that it's not taught, it's usually not taught individually, right?

1:19:11 EN: It's usually taught in a group format because we all did... We opened this with a meditation and if we had then gone into an inquiry about that experience, those who found that something difficult came up or that they were distracted or if their mind was wandering or that they felt like how can I possibly sit still through this. I'm a horrible meditator. All I want is a sandwich and I can't stop thinking about that cute guy I saw on the subway, and what's going on here. I'm just distracted. Realizing one is having that experience is one thing, but then to kind of see the humanity in that is another very powerful thing and that's not something... You could understand that intellectually, it's quite another thing to experience it with a group of people.

1:20:01 EN: I think one of the nicest things we've been able to do with the psychedelic program this year is to start a group where people, we have an actual psychotherapy integration group. There hopefully will be more of those in the future and other places if people can kind of get that connection in a safe and private space with consistent relationships but also continue to explore that process.

1:20:22 Speaker 7: So you talked about the legitimation of being able to talk to your therapist before and after and feel safe in having that conversation. I kinda wondered what your view is of expanding the kinds of professionals who might get that training and be able to support people, whether it's my doctor, my nurse, my personal trainer, my career coach. Who else in professional settings needs to be aware of how to integrate that experience into how they're supporting me.

1:20:57 EN: Well, I think everybody does.

[laughter]

1:21:02 EN: I would say across the board, if you go to your high school guidance counselor and tell them... Wanna tell them about your experience and they look at you like you've got two heads that might be something we would like to help them learn about so that they can look at you and give you a nice, non-judgmental harm reduction framework, put it that way. Yeah, I mean, within the mental health field, I think what's great is that we do have a lot of mental health practitioners that are interested and that are curious, and that a lot of the skills that therapists tend to have are already great and really well-geared for talking with people about these experiences. Therapists are often very good at helping people feel safe and holding space and being attuned to their emotional experience and advocating for people or helping people advocate for themselves.

1:21:54 EN: So there's a wealth of skills there, and in our experience, a lot of curiosity and a lot of people that are eager and ready and willing to learn. Therapists are coming in and saying, "My patients are asking about this, and I don't know what to say and I really wanna help better so can I get some training?" So I think it's a great place to start. I would really love to see more medical doctors, medical professionals, nurses and people in other healthcare and helping fields also be if not prepared to provide psychedelic harm reduction therapy at least educated enough to be able to have an open dialogue with people. And I think that's kinda gonna naturally happen as the media picks things up and there's more and more news about it and everybody reads Michael Pollan's book, which was on the top 10 books of 2018 list. Yeah, so more recognition for that. I mean, the more widely read it is that that will also trickle down and help.

1:22:56 IG: So we've had nurse practitioners and MDs come to our workshops, which is awesome. And also sort of this is the... Again the psychedelic integration workshop, but then I think people are also sometimes curious about somehow participating, facilitating, playing a role in psychedelic treatments, and it's still very, very, very early in terms of how this is evolving in terms of clinical trials, they're very strict. There's certain criteria, but perhaps there'll be a future not so far... Not so long from now, maybe five, 10 years where there's really an interdisciplinary team of people who are working in the psychedelic therapy process where it includes people who are artists or art therapists, musicians. There's so many permutations of this that we might see at a future psychedelic facility center, or something like that. So it might not necessarily be somebody who is just like next to the person while they're on the psychedelic and doing talk therapy. It could look very different, and that's who knows...

1:24:07 PA: Yeah, who knows. That's it. And that's great way to end the Q&A so again, thank you so much for your time. Thank you so much. Thank you to all of you for showing up and being here.

[applause]

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