Marc Aixalá, psychotherapist, holotropic breathing facilitator, founder of the ICEERS Support Centre and now also a writer, has just published a book that looks set to become an instant classic: ‘Integración psiquedélica’, published simultaneously in Spanish by Eleftheria and in English by Synergic Press (with translation by Adam Aronovich), was born “as a ‘self-reflection’ to clarify in writing the ideas of what I had learned in these years”, as Marc explains to us in this interview, which you can watch and listen to in full here:
Is integration a part of the psychedelic process unique to the Western world or is it also practised in traditional cultures?
It’s not that indigenous societies don’t practice integration, but they do it in a different way, or at least they have a different consciousness than Westerners. When we have started to use these substances, and I am talking about since the 1950s, the type of experiences they induce are so alien to our worldview, to our way of understanding reality, that they produce a kind of disruption in our everyday perception of life. They open us up to a reality that does not fit in very well with our everyday reality and, in fact, we give these states a name as if they were something different from everyday reality: non-ordinary states, expanded states or altered states. Therapists who used these substances, both psychoanalytic and more transpersonal, realised that the experience may be very interesting, but it was somehow very alien to the personal reality of the person experiencing it.
After taking a psychedelic you see the world brighter for a few days, but then it fades away. How do I sustain any of this? Then we start talking about integration. Indigenous societies often don’t have such a radical distinction between the reality perceived in our day-to-day lives and the reality perceived in altered state experiences. They call them reveries or dreaming. They don’t have the same verb for dreaming as for hallucinating. So for them it is not a perception that is completely alien to everyday life and, in fact, they have a number of practices that are part of the integration.
Sometimes it’s about the diets or food restrictions that certain peoples prescribe before and after the experience. But in general there is already a shared vision of what it is to use these plants. In a society that uses ayahuasca and knows that a certain person in the neighbourhood has been in treatment with the curandero that week or that weekend, if on Monday they see them there as a little hesitant and still a little vulnerable, they understand perfectly well. On the other hand, in our society, you go to a weekend ayahuasca workshop and then return to the office on Sunday and you don’t feel the same. So you have to make quite a radical change of chip and that’s why we talk about integration in this context, because we have to do something so that these experiences can be used.
The first thing you did in the book was to investigate what is being done, because there is no single integration. Although it’s relatively recent, it’s already branching out, is that right?
That’s right. When I started to take an interest in integration, to give talks, to give courses, to share the work we are doing at ICEERS, my first question is: what is integration? I start to wonder whether we all really understand the same thing by integration or, on the contrary, it is a word that we say and we think we understand each other, but then it is not so. And when I start to investigate I discover that everyone does a bit of what they want. There is no established structure of what integration is. The book does not try to propose a strict definition of what integration is, but rather a reflection on what integration is. So I explain what integration is through metaphors, I talk about different dimensions of integration and I also review integration practices throughout the history of Western psychology. When I was talking about integration, I tried to dig into papers and articles from the 50s, 60s and 70s to understand how they understood integration. When I started to write this book I started to explain how I do integration, and I do it in an explicit way, so that there are no mysteries and no secrets.
Would you say that good integration work is currently being done in Spain?
That’s a difficult question to answer. In the last ten years there has been a boom of facilitators, shamans, therapists… and it is difficult to know what everyone is doing. I would say that everyone is doing some integration work, that is, almost everyone is aware that after the experience something has to be done. Most groups probably offer mandala drawing and a sharing group, sometimes only the latter. These groups can be done in a thousand ways. Integration practices are being done, some more successfully than others.
In what situations is integration necessary?
I see two main scenarios for integration: when the experience has gone well and the person has no difficulties. In that case, it doesn’t matter a bit what you do because it will go well, it doesn’t pose a big problem. These are activities to maximise the benefits of the experience. When there have been difficulties, these kinds of techniques are not usually helpful. It is the latter that I have focused more on, and the objective in this case is to mitigate adverse effects. Here the type of practice is more specific and here I think a person with clinical experience, a psychologist or a therapist, is concerned. I think few facilitators have the tools to support when difficulties arise.
I understand that many of these facilitators are self-taught as far as integration is concerned.
I understand that this is the case, and I don’t think it’s wrong. When you go to the doctor, the general practitioner sends you to the surgeon, who does the operation but doesn’t care much beyond that. In psychedelic medicine, maybe it’s something similar: there are those who are more family doctors, who accompany you before and after, and certain specialists who intervene during the experience. So not everyone has to know everything. I think there is room for everyone to specialise in what they are best at.
Just as you can come out worse than you went in from the psychedelic experience, you can also come out worse from a poorly done integration. Is there a risk of this?
When a bad experience with the substance happens, what happens is that the person does not go back to the shaman or facilitator, but seeks alternative help. It is also true that even if the experience has gone well, the facilitator can be quite confrontational and in a state of vulnerability after the experience, certain interventions can destabilise and shift the focus of the experience to the feedback given by the facilitator. This can be a source of problems, it is what I call “problems with facilitators”, it is one of the common casuistry that happens in integration: not so much during the experience but with the personal relationship with the facilitator.
In fact, the genesis of the book comes from the experiences of people who had problems during or after sessions with psychedelics and turned to a ‘neutral’ actor like ICEERS and its support centre.
Sometimes the structure of the retreats doesn’t make it easy to follow up afterwards. I’m thinking of these tours of Europe by famous healers from South America. It’s a structure that doesn’t facilitate follow-up and makes people turn to other people to integrate what happened there. When we started doing this in 2013 with ICEERS there was almost no integration, but now there are many more options.
Someone might think that this integration thing is an invention of psychologists to take advantage of the Psychedelic Revival…
This is a very important question. I say it and I hope it is clear. I am a therapist and I do it for a living, but I understand that therapy is something unnatural, it is not a state that is meant to last for a long time. My understanding of integration is even narrower than that of therapy. I understand that it is necessary when the person is worse than they were before and feels they need help. The format I have developed is brief, a maximum of ten sessions, and I like to make the distinction between integration – which seeks to bring the person back into balance and take back the reins of their life – and psychotherapy.
Have you ever considered the use of psychedelics to resolve psychedelic-generated crises?
In the book I propose a conservative approach. If something can be done by playing a little, all the better. Before proposing to do another experience, I like to do a round of five or ten sessions to remove the most uncomfortable symptomatology: panic, anxiety, insomnia, intrusive thoughts… it makes sense to do a new psychedelic experience, but I think you have to be very nuanced, and see when the time is right. What I propose is to do a session with holotropic breathing, which is a method of consciousness modification that can be very intense but provides a greater sense of control, so it is less scary, and if you have to go back to the place you were, nobody is pushing you but you pull yourself.
How do you integrate the psychological worldview with the indigenous one, populated by spiritual entities and attacks?
This is a crucial question for any therapist working with psychedelics, because people who have experiences in altered states of consciousness have many different experiences. My way of solving this is from a philosophical position of understanding the nature of reality: I don’t think it makes much sense to have rigid beliefs about what is and what is not. If you do, I think it is useless to force that perspective on your patient. I start from constructivism, which is a school that holds that reality itself does not exist, but that each person constructs his or her own reality. The effort then is how can I try to perceive reality as this person who is asking me for help perceives it, and help this person from his or her own reality. It doesn’t matter if I believe that spirits exist or not, but as a professional I have to honour the person’s reality.
What do you think of the phrase “One ayahuasca session is equivalent to seven years of psychoanalysis”?
I like to make a point. I think you have to ask yourself what kind of therapy it is equivalent to. When this phrase, which is attributable to the first psychedelics of the 1950s, was invented, one might ask, what are the expected results of ten years of psychoanalysis? There is another thing: people tend to have a lot of experiences, especially in the world of ayahuasca: if you have taken it less than 40 times, you are taken for a novice. Calculate now how many hours you spend in those 40 ayahuasca sessions, 240 hours… in 240 hours of therapy you also do a lot of work, I don’t know anyone who has done so much therapy. In a psychedelic session you produce a lot of unconscious material that would take years to produce in therapy, but this does not mean that more material is a guarantee of better therapeutic results.
How many times would someone with depression have to take psychedelics to start to perceive that it works for them? Probably more than once but less than ten.
What shadows can we find, on a therapeutic level, in the so-called ‘psychedelic renaissance’?
There are several: we are starting to use psychedelics as one-off events. In psychedelic research there is a lot of emphasis on the experience a person has had with a substance – psilocybin, MDMA, ketamine or whatever – rather than the emphasis on the process. I think psychedelics are good catalysts for processes, good keys that open doors for things that can happen, but they are rarely the end point of anything, they are often the starting point. If we are sold these substances as a magic pill I think we are missing the point. One of the shadows would be that we lose a certain complexity, a certain richness, in understanding the nature of these substances and trying to put them as medicines: take this and you’ll get this other thing. It’s a very crude medical simplification.
Another shadow that exists is in the trivialisation of this kind of experience, a substance that can be given by a psychiatrist and is therefore devoid of any spiritual, social, relational or even ecological aspect; it becomes merely intrapsychic, and I believe that psychedelics are just that.
Finally, to become a psychoanalyst you have to do your own psychoanalysis. To become a healer, too. I think we are seeing a fever of how to train psychedelic therapists fast. On the one hand, I think it is possible to do it, but on the other hand, we lose some wisdom and deeper knowledge. We run the risk of losing the human resignation by giving it only to medicine.
In fact, indigenous people themselves complain that today’s healers do not have the years of diets that their elders had.
It may not be so black and white, and there may be different roles. Someone can be a good companion for psychedelic experiences even if they have not done a very deep or lengthy process. This does not mean that this good companion should be required to be a good guru or spiritual teacher. A companion does not have to be a shaman or even a wise person, but a good technician and a good person, who does not play at being someone he or she is not. The problem is when someone tries to sell himself beyond what he is capable of. Honesty is the main thing. I have had the pleasure of meeting very capable and humble therapists who understood that their role was one of accompaniment and that healing came from within the person.
Marc Aixalá’s website and contact.
“Ayahuasca can help with illnesses caused by our hyper-individualistic society”, Plantaforma, 19 May 2021.