We apply transdiagnostic clinical approach to work with patients who are using or considering using Entheogens or Psychedelics in any context. Given the prevalence of psychedelic use, the therapeutic potential of entheogens or psychedelics, and the unique cultural, social, ethnic, religious or spiritual, and/or historical context in which entheogens or psychedelics are located, it is important that mental-emotional healthcare providers understand the unique and special motivations, experiences and needs of the people who use them.

We incorporate elements of Entheogenic or Psychedelic Psychotherapy with Harm Reduction Psychotherapy, where it can be applied in both brief and continuous interactions. Likewise, we hold a position of acceptance, empathy and compassionate and destigmatizing. Considerations for assessment, preparation, and therapy are emphasized, especially with difficult experiences.

Lets start by defining Hallucinogens, Psychedelics and Entheogens:

Hallucinogens, are derived from the word hallucination. The term hallucinate dates back to around 1595-1605 CE and it originates from the Latin hallūcinātus, the past participle of (h)allūcināri, meaning "to wander the mind". In adittion this term is a pathological word in Psychology and Psychiatry.

Psychedelics, the term was coined as an alternative description of hallucinogenic substances in the context of psychedelic psychotherapy, irregularly derived from the Greek words ψυχή psychḗ 'soul, mind' and δηλείν dēleín 'to manifest', meaning "manifestation of the mind”, that is, manifestation of different mental-emotional states and is a very broad term that is applied to various compounds and experiences with subjective effects related to a non-ordinary states of consciousness and experiences of oneself and everyone and everything; as well as increased awareness of mental-emotional processes.

Entheogens are psychoactive substances that induce changes in perception, mood, consciousness, cognition and/or behavior with the purpose of generating spiritual development or evolution or otherwise, in sacred contexts.

That is why, for us, the most appropriate term to use is the term Entheogen, which is derived from two ancient Greek words, ἔνθεος (éntheos) and γενέσθαι (genésthai). The adjective entheos translates as "filled with the divine, inspired, possessed," and is the root of the word enthusiasm.

The Greeks used it as a term of praise for poets and other artists. Genesthai means "come into existence." Therefore, an Entheogen is a medicine that causes one to feel inspired or experience feelings of inspiration, often in a religious or spiritual way.

This is why the term Hallucinogen is inappropriate due to its etymological relationship with words related to delirium and madness (mentioned above), and the term Psychedelic is also considered problematic, due to the similarity of sound with words related to psychosis. and also due to the fact that it had become irreversibly associated with various connotations of 1960s pop culture.

For this reason, we decided to use Entheogen as synonym of more appropriate term than Hallucinogens or Psychedelics, to contrast it with the recreational use of the same substances.

Likewise, Entheogens are used for religious, magical, shamanic or spiritual purposes in many parts of the world. Traditionally, they have been used to supplement many diverse practices aimed at achieving transcendence, including divination, meditation, yoga, sensory deprivation, asceticism, prayer, trance, rituals, chanting, imitation of sounds, hymns in Hikuri or peyote songs, drumming and ecstatic dance. The psychoactive experience is often compared to non-ordinary forms of consciousness such as those experienced in meditation, near-death experiences, and mystical experiences. Ego dissolution is often described as a key feature of the psychoactive experience.

Our Integral Holistic Transcultural Transpersonal Therapy is based on mindfulness and therapies that provide a framework for examining and working with clinical entheogenic experiences, with care being taken to provide entheogenic experience as part of the treatment.

Harm reduction is a perspective based on empathy and compassion towards the patient and focuses on reducing harm if it is caused by the use of entheogenic substances. This perspective emphasizes the appreciation of the autonomy and personal rights of a patient, respecting their values and preferences, and working to help them expand their options and participate in individual and thoughtful decision-making and goal-setting, related to the use of Entheogens, which makes this approach exceptionally personal, unique and special. This paradigm is associated with the transcultural, transpersonal holistic integrated approach to entheogen treatment, in which both the possible abuse and underlying psychopathology are treated together. This approach may be appropriate for users of entheogens, who may be using them to treat psychological and/or psychiatric symptoms, or to promote growth and evolution, and who generally do not experience possible negative consequence of entheogen use. In fact, these entheogenic compounds may have anti-addictive properties.

What does the Administration of Entheogenic Psychotherapy look like?

Entheogenic Psychotherapy consists of the administration of an entheogen in the context of a psychotherapeutic setting and relationship, with the therapist providing psychological backing, support and accompaniment, as well as a specific intervention before, during and after, designed to align with the entheogenic experience and promote change in the given diagnosis, if it exists.

Entheogenic experiences have been called Non-Ordinary States of Consciousness. As well as drawing on harm reduction psychotherapy as an approach to working with people who use entheogens, our work is rooted in interventions based on mindfulness, entheogenic psychotherapy and psychodynamic therapy to understand and integrate non-ordinary states of consciousness in clinical practice.

Mindfulness-based treatment modalities teach concentration, meditation, yoga, pranayama, and mantra practices and skills to apply the resulting insights to reduce stress, tension, anxiety and distress, including anxiety associated with mental-emotional health and possible substance use problems of entheogens.

These modalities also teach an attitude of open, nonjudgmental, and nonprejudiced curiosity toward whatever the patient experiences, both during meditation, concentration, yoga, pranayama, and mantra practice and throughout life. This shift in attention and attitude results in a profound change in the way people relate to the causes of their distress, resulting in relief.

Our work is based on this orientation, considering entheogenic experiences as a type of non-ordinary awareness experience, similar to those achieved through meditation, concentration, yoga, mantra, pranayama and martial arts, asking patients to develop the same sense of open, nonjudgmental, and nonprejudiced curiosity toward their entheogenic experiences and all that surrounds them as in mindfulness-based modalities. It is paramount that therapists practice, cultivate and embody the same attitudes, so these can explicitly be set and modeled for the patient.

Traditional psychotherapeutic approaches have viewed strong, healthy ego functioning as the central goal of successful therapy, and view pathology as the result a stagnation of ego development or a breakdown in ego function. Our everyday sense of self often changes in response to environments, relationships, and challenges, and requires a degree of flexibility, yet these models do not offer a framework for healthy, mature ego development beyond becoming stable and capable to meet the demanding challenges of life. Mindfulness-based modalities, integral holistic transpersonal transcultural psychiatry and psychology, and the corresponding understanding of non-ordinary states of consciousness, in which the sense of self may be changed or completely dissolved for a time, offer a profound framework for assessing and work with ego dissolution and related penetrating experiences that can occur under the influence of entheogens. In its basic principle, integral holistic transpersonal transcultural psychiatry and psychology conceptualizes the ego as a source of perpetual distress and anxiety and teaches that moving beyond a fixed sense of self reduces that perpetual distress and anxiety, seeing it as a more advanced stage of healthier and more holistic integral development. While healthy and holistic functioning of the ego is necessary for survival and for moving towards contemplative practice, it is not seen as the ultimate goal but rather as a stage of healthy integral development with inherent ongoing struggles, beyond which one can ideally advance. For therapists working with people who use entheogens, this integral, holistic, transcultural and transpersonal understanding helps to take a non-pathologizing approach to working with experiences of ego dissolution and finding ways they can be helpful, healthy, and wholesome for the patient.

What is Inquiry in Entheogenic Psychotherapy?

Inquiry, a component of mindfulness-based interventions, is a dialogue of improvisation and spontaneity that constantly facilitates the focus of mindfulness on the participant's experience in a particular way. Inquiry involves the application of open, nonjudgmental, and nonprejudiced curiosity in communication, allowing the conversation to unfold in a way that values the patient's experience, honours their intuition, and supports and encourages their own autonomy. Among the most relevant features are the following:

1. Focus on understanding instead of agreement.
2. Take turns listening to each other with an open mind and brain to avoid conflict or power struggles.
3. Actively practice healthy, comprehensive dialogue and use mirroring techniques.

A therapist's solely involvement in problem solving and/or unsolicited advice or interpretation of the patient's experience can inhibit the patient's intuitive process and detract from the healthy and comprehensive development of their autonomy. Therefore, it is more appropriate for therapists to focus on what the patient has tried, what they think and feel about the situation, what they see as possible solutions, and what their intuition tells them. The conversation constantly redirects the patient back to their own experience, so that insights are nurtured, developed, and integrated. In our work, inquiry informs the exploration of entheogenic experience in such a way that insights are developed consistent with the noetic quality of such experiences.

How is our Holistic Integral Transcultural Transpersonal approach developed in Entheogenic Psychotherapy?

Our integral, transcultural, transpersonal, holistic approach takes into account the mental-emotional, social, cultural, ethnic, spiritual and/or religious context, because each person is unique and special, in this way our entheogenic therapy manages to adapt to each person and their experience and needs.

In addition, it is associated with the non-directive approach, which has been a central principle of entheogenic therapies, prioritizing patience, tolerance, openness and guidance instead of instruction, since the instruction is based on a pre-existing idea of the fundamentals and the best course to solve a specific problem. The goal of this nondirective approach is for the patient to take an uncritical approach to their own entheogenic experiences and engage in self-directed processes of information seeking and meaning making. As such, rather than articulating instructions to a patient, it is more appropriate to dialogue openly with understanding to make suggestions for consideration or action. Similarly, patients must determine what aspects of their experience they wish to reveal, thus reinforcing autonomy and personal choice. Therapeutic presence reflects total engagement in moment-by-moment and step-by-step encounters with patients and establishes a mutual and healthy relational connection that builds trust and freedom.

IIt is also associated with the internally directed or inwardly directed approach, where the therapist refers and encourages the patient to search within for their ideas, needs and solutions around their experience; because, when entheogens are administered to a person, they are the ones that produce their own unique and special content, while we therapists follow, accompany and support patient’s experience. Thus, there is an inner healing intelligence. We all know that's true for our bodies, if you scratch or break a bone, your body has a mechanism to heal itself. There is this wisdom of the body to try to sustain itself. It is similar that this function exists for mental-emotional states. 

The term inner healing intelligence captures this inwardly directed focus, which can also be conveyed as intuition or inner healing ability. The inner-directed approach is consistent with harm reduction and the integration with entheogenic psychotherapy, as it values patients' autonomy, responsibility, opportunity, and ability to choose their own goals and courses of action.

What is Integration and Harm Reduction in Entheogenic Psychotherapy?

Integration and Harm Reduction in Entheogen Psychotherapy is a somewhat novel paradigm designed specifically for those who use entheogens and need clinical support to prepare for and/or integrate entheogenic experiences. It is informed by the evidence based on clinical trials and numerous experiences of entheogenic psychotherapy such as in ceremonies, but maintains a focus on the unique and special needs of people who use entheogens.

Our work involves supporting, helping, and promoting exploration and enhancing understanding in patients developing a relationship with entheogens, the administration of entheogens, or the provision of entheogen therapy during the entheogenic experience. Therapists address the unique and special needs of the patient, such as co-occurring mental-emotional health conflicts or difficulties, potential symptoms that may persist after entheogenic experiences, and processing potentially dazzling and/or revealing or overwhelming and/or disappointing experiences. Therapists also assist and reinforce patients seeking to maintain the benefits of helpful, comfortable, dazzling, and/or revealing entheogenic experiences. The goal of integration is to merge the entheogenic experience with the patient's daily life in a way that helps the patient live a fuller, healthier, more comprehensive and joyful life with less or no distress.

Our work is consistent with characteristics commonly found in various psychotherapeutic orientations, such as establishment of safety, relationship, connection, empathic and compassionate presence, honesty, integrity, professionalism and ethics, agreement on the task of therapy, positive regard and the authentic presence of the therapist. Therapists may combine their own practice orientations and diverse treatment modalities in the process of integration and harm reduction in entheogenic psychotherapy to address a specific diagnosis or symptom presentation or conflicting mental-emotional states.

Integration and harm reduction in entheogen psychotherapy also incorporates mindfulness-based therapies and relational psychodynamic approaches to create a framework for working with patients presenting in the decision-making process before, during, and after entheogen use, to receive the help of a doctor or psychiatrist. The integration and harm reduction model in entheogenic psychotherapy offers an integral holistic, transcultural and transpersonal paradigm for working with people who use entheogens, enriches the process by offering progressive perspectives on decision-making and meaning-making processes, and recognizes and works with the variety of relationships that patients have with entheogens, from totally beneficial to relatively harmful.

How can one apply harm reduction psychotherapy in the case of so-called hallucinogen persistent perception disorder (HPPD)?

Hallucinogen Persisting Perception Disorder (HPPD) is a disorder that can affect some people who use entheogens or have used them in the past. It is characterized by having memories and/or visual disturbances that mimic the effects of entheogens, such as lights, shiny objects, etc. These flashbacks occur randomly and are primarily visual in nature. They can make some people feel disoriented or uncomfortable, especially if the flashbacks occur at an inopportune time, such as while driving, studying, working, etc. For an individual diagnosed with HPPD, the symptoms cannot be due to another psychological psychiatric medical condition, in fact, HPPD is distinct from psychological regressions for reasons of its relative permanence; while the setbacks are temporary, the HPPD is persistent.

The real difficulty with HPPD is the distress, resulting in anxiety, depression, isolation, panic attacks, unhealthy coping mechanisms that people may develop to overcome it (alcoholism and drug dependency are sadly common among HPPD patients). However, there are many people who live with significant visual changes and do not find them distressing; rather, they can be sources of enjoyment, artistic inspiration, deliberate support as part of a spiritual practice, etc.

In the case where a patient is experiencing HPPD, probably his/her first priority would be to overcome the distress, for which reason the holistic, integral, transcultural and transpersonal Harm Reduction Psychotherapy is recommended, necessary and wholesome, since it will achieve a decrease in his/her fixation, attention and notoriety of disturbing images or visions. In addition, the patient will be able to establish and balance his/her mental-emotional state, he/she will learn to filter the disturbing visions that with appropriate, specific and necessary tools and techniques will disappear over time.

How does one wholesomely address distress and reduce imagery in HPPD?

• Exercise, elimination of processed foods and changing to specific and healthy diets are also recommended.
• As we mentioned before, holistic integral transcultural transpersonal harm reduction psychotherapy is essential, recommendable, necessary and wholesome.
• In order to identify and manage them, pay attention to the triggers of visual disturbances. This will provide more information to the overall therapeutic work. These can be: fatigue, stimulating foods (caffeine), anxiety, tension, stress, the inner environment (dark and closed rooms, meeting people who had entheogenic experiences or who were together during an entheogenic encounter, etc.), specific foods, fixation and attention to looking for images, consumption of alcohol, illicit drugs, other entheogens or any pharmacological substance. Also, pay special attention if the manifestations are only visual, or there are also symptoms of depersonalization/derealization disorder. 
• Concentration and mindfulness exercises, meditation, mantras, yoga, martial arts, etc., will also have the effect of reducing distress, anxiety and tension and stress.
• Entheogen Integration Psychotherapy always goes hand in hand with our holistic integral transcultural transpersonal Harm Reduction Psychotherapy; the process of joining both psychotherapies, will not only allow the patient to improve their conflicts and mental-emotional distress, but also it will help one understand and integrate one's entheogenic experience, truly bringing one into a new relationship with oneself and others.

How can the risk of developing HPPD be reduced after taking entheogens?

Entheogens affect the mind brain for up to a week (or more) after ingestion. Because of this, HPPD can take time to show itself.

However, to avoid HPPD, it is first important to ingest entheogens in a clinical, ceremonial and/or sacred manner with a health professional who has the personal experience and possesses honesty, integrity, and professional ethics, and wholesome management of the entheogenic and unconscious realm, especially the shadow aspect (see in the following document “The Shadow and Entheogenic Psychotherapy”). In addition, there must be established an appropriate, adequate and healthy environment.

In order to reduce the risk of developing HPPD, it is recommended:

• Sleep well, take care of both the quality and quantity of sleep and the external environment.
• Avoid the consumption of any type of entheogen, in any presentation and formula. Do not consume alcohol or tobacco. In addition, it is advisable to ask one's psychiatrist to begin to reduce and finally discontinue any psychoactive drug. (Depending on the mental-emotional, biological, social, cultural, ethnic, religious and spiritual factors of the person.)
• Attend Entheogen Integration Psychotherapy, where one can talk openly and in confidence about the entheogenic experience.
• Do not expose oneself to stressful, tense, anxious or depressing situations.
• Reduce screen time (such as cell phones, television, computers, etc.), since one's mind brain is still processing the entheogenic experience and excessive screen time can cause a disincarnation effect.

Who could benefit from Entheogenic Psychotherapy?

Some examples of people who might benefit from integration and harm reduction in entheogenic psychotherapy are those who might have used an entheogen on their own in an attempt to resolve a psychological or psychiatric symptoms; someone who has spontaneously ingested an entheogen and consequently experiences psychological distress; or someone who intends to use an entheogen but is unaware of the potential benefits and risks. Similar to entheogenic psychotherapy, there are some therapeutic tasks that are appropriate before the patient's use of an entheogen, and others more suitable during or after. We found integration and harm reduction in entheogenic psychotherapy helpful in structuring sessions as preparation sessions, sessions during entheogen administration, harm reduction sessions, and integration sessions accordingly.

How is our Psychotherapeutic work with Entheogens?

Our Psychotherapeutic work with Entheogens can be conceptualized in three stages:

1. Preparation: this stage consists of collecting all the data and details of the mental-emotional, social, cultural, ethnic, religious and spiritual context of the person, with specific psychological-psychiatric tools and questionnaires, which are the Informed Consent, Patient's Medical History, Life history (from the moment of birth to the current situation), Harm reduction therapeutic agreement and necessary medical-psychological-psychiatric evaluations.
2. During the administration of entheogens: at this stage the therapist will guide, support and help in an adequate, healthy, honest, integrated, empathetic, compassionate and understanding manner the person who finds himself/herself in non-ordinary states of consciousness, with the purpose of that they have a revealing experience and can progressively understand their mental-emotional states, distress, conflicts and assist the patient to live a fuller, healthier and more comprehensive life.
3. Integration: in this stage of entheogenic psychotherapy, the patient is motivated, encouraged and incited to reveal the understanding and learning about the entheogenic experience and is given various tools to carry out a process of integration of mindfulness, meditation, concentration, yoga, pranayama, mantras and martial arts to his/her daily life and to the new experiences he/she may have.

In addition, patients sometimes begin integration and harm reduction in entheogenic psychotherapy after their entheogenic experience, making it necessary for the therapist to adjust their assessment and selection of therapeutic tasks accordingly.

What is the Evaluation of Integration and Harm Reduction in Entheogenic Psychotherapy?

Although it is necessary to use the ICD-10 or a similar manual according to the standards of the therapist's region for differential diagnosis in the evaluation, it may be useful to ask specific questions of integration and harm reduction in entheogenic psychotherapy, such as whether the entheogenic experiences of the patient were spontaneous or planned. Possible risks associated with the use of entheogens can be minimized when circumstances provide the potential for a safe and desirable experience. Still, spontaneous or unplanned entheogenic use in unsupportive circumstances may have clinical relevance. Therapists may also ask patients about the outcome of their entheogenic experiences thus far, and specifically whether the patient has derived any meaning or purpose from them. Entheogens have been reported to have properties that enhance purpose or evoke a meaning response that moderates therapeutic outcomes. Some participants reported that their first entheogen experience in a clinical or ceremonial setting was among the most personally significant events in their life and of great spiritual significance.

During the evaluation, therapists should understand a patient's relationship with entheogens, especially their motives for use and any resulting dazzling or potentially overwhelming experiences. This includes taking a medical-psychological-psychiatric history, obtaining the patient's reason for seeking help, and inquiring about the patient's history of entheogen use. Motivations for seeking an entheogenic experience may include recreation, therapeutic healing, spirituality, or personal growth. Asking about these additional features among other general questions helps improve the entheogenic integration process and produces significant positive results.

It is also useful to measure the patient's connection to a community of entheogen users. Such participation can be nuanced, creating a dynamic relationship that can be supportive in some respects and limiting in others. The harm reduction and integration therapist in entheogenic psychotherapy must understand the worldview of the patient's community, the extent to which the patient subscribes to that worldview, and the impact of creating a therapeutic relationship within that context.

Another important point for integrating meaningful entheogenic experiences involves identifying goals and barriers to integration during the assessment and measuring how the patient defines successful integration. Even with proper planning for integration, challenging experiences can arise that can be troubling for both patient and therapist. However, therapists can learn to recognize and help manage these challenges.

In our work, preparation for an entheogenic experience is guided by the patient's reasons for using an entheogen. The therapist must inquire into the nature of the patient's motivations. Whether they reflect an interest in spiritual growth, symptom reduction, well-being enhancement, or a desire to enhance creativity, knowing the context and how the patient is going to use entheogens will shape treatment and is vital to comprehensive, appropriate, necessary integral holistic transcultural transpersonal clinical care. Preparation does not only imply that a person will use an entheogen, but also helps the patient to participate in an ongoing self-research process so that he/she can make an appropriate decision for himself/herself. Preparation can address misinformation, dispel myths, and provide necessary education about entheogens. Assessing a patient's level of knowledge about entheogens and providing adequate information and appropriate resources are essential elements of therapeutic preparation for an entheogenic experience. After the initial evaluation, therapists provide vital information on the basic effects of entheogens, for example, subjective effects, beneficial effects and possible physiological risks, mechanisms of action, expected duration and intensity, side effects, etc. This part of our work is based on an integral psychoeducational approach that aims to increase the knowledge and perception of the patient on the subject in question. The main ways to achieve this are the honest and integrative exchange of information between the patient and the therapist, as well as the active communication of information, which makes the patient's experience more open leading to a more positive and progressive therapeutic result.

It is important to note that the content of this topic about the specific interactions of benefits and possible relative risks of entheogens may vary depending on the therapist, whether it is a psychotherapist, a prescribing therapist, or another mental-health professional, such as a psychiatrist. Therefore, it is of a prime concern that the therapist clearly delineates harm reduction practices for the clinical or ceremonial use of entheogens which the patient chooses on their own as well as recommendation or referral for the use of an entheogen for mental-emotional health support or treatments.

Entheogens as non-specific amplifiers and the importance of Set, Setting and Skill

Additional useful preparation foci include the introduction of the paradigm of an entheogen as a non-specific amplifier. This notion is based on the observation that entheogens tend to intensify mental-emotional phenomena and amplify their meaning, presenting them as larger and broader than they would have been without entheogens. This leads to a manifestation of otherwise latent psychological-psychiatric processes, an increase in metaphysical thinking, and an enhancement of meaning that is crucial in therapeutic work. As with any entheogenic and non-entheogenic substance, the concept of Set, Setting and Skill plays an important role in entheogenic experiences; set here refers to the experimenter's intentions, attentions, expectations, and general and specific mental-emotional state; while setting refers to the environment (where, with whom, etc.) in which the entheogenic use takes place. Some also use the term cast to describe the people present during the entheogenic experience: therapists, shamans, companions, or other participants in the clinical use or ceremony. The intentional and attentional use of the medicine explicitly profounds the entheogenic experience as the clear recognition of the various skill sets (which can be tested and verified) one uses allows one to further develops them at all times. Entheogenic experience is not something that just happens to one; it’s an experience to directly and mindfully engage with. Thus this shift in orientation leads to some truly positive results and takes out the need for any particular belief system.

It is important to prepare the patient for the fact that aspects of their experience can be amplified and that the quantity and quality of their experience is highly dependent on set, setting or cast and skill of an entheogenic event. These factors are crucial in the formation of the experience, and their influence can be increased by the effect of entheogens.

Meaning can also be amplified during an entheogenic experience. This effect can be very useful in therapy as well as increasing creativity and spirituality. Because of their meaning-enhancing aspect, entheogen-induced revelations tend to feel more meaningful than non-entheogenic ones. This can lead to decreased self-inhibition and self-criticism, and a greater focus on creativity. However, the significance of the resulting creative achievements can also be amplified under the influence of entheogens or shortly thereafter. Discussing these issues in advance can better prepare the patient for a non-ordinary state of consciousness and help them find meaning during and after the experience.

Why are Self-Regulation Tools Important in Entheogenic Psychotherapy?

As we have mentioned before, in the devising program it is important to obtain all detailed information from the patient and provide him/her with adequate, necessary, honest and comprehensive preparation. Because in the entheogenic experience, non-ordinary states of consciousness can function as a powerful catalyst, causing profound mental and emotional insights, when a patient is in this state, trauma processing can be done in a planned or spontaneous manner. Preparing a detailed re-entry plan in advance can help better management and integration of such experiences.

As with any trauma approach, equipping the patient with the proper and necessary self-regulation tools in advance can make all the difference in the management and relative outcome of trauma symptoms. Such tools may include the practice of mindfulness, concentration, reflection, journaling, meditation, yoga, mantras, pranayama, and martial arts, as well as grounding and self-care practices to assist the patient to focus and manage the outside world, his/her inner world of thoughts, feelings, and emotions, being relatively positive or negative, by concentrating on the bodily sensations that arise in the environment around him/her. As a result, the patient's focus shifts from trauma symptoms to self-reflective deep processing. Planning time to rest and recover after an entheogenic experience can help facilitate processing and integration by giving the patient time to reflect on their thoughts, feelings, and emotions. After the effects of the entheogens wear off, the therapist and patient should dialogue regarding any insights gained as well as the content of experiences of non-ordinary states of consciousness.

Why is Expectancy Management important in Entheogenic Psychotherapy?

Managing expectations is particularly important in preparation. Any apparent disappointment or misunderstanding felt by the patient can affect his/her perception of the entire entheogenic experience. Such apparent disappointment or misunderstanding may be related to a discrepancy between expectations and results. Among the experiences frequently sought is the metaphysical experience, which focuses on the objective ontological understanding of the world and/or the mystical experience, focused on the subjective experience of the world: a non-ordinary state of consciousness that includes a unitive quality (being one with the universe), a feeling of wonder or sacredness, ineffability (the inability to express one's experience in words), transcendence of time and space, a noetic quality (sense of revelation), and a profound, positive and bedazzled mental-emotional states. A main characteristic of a metaphysical and/or mystical experience is a unitive quality related to the dissolution of the ego. Experiencers of clinical or ceremonial use have reported that an entheogen-induced metaphysical and/or mystical experience is one of the most significant events of their lives. Such experiences have been positively and progressively correlated with a lasting increase in well-being, openness, and decrease in various types of symptomatology, and are therefore commonly sought after by users of entheogens. However, not all cases of entheogenic use will result in a metaphysical and/or mystical type of experience, and a strong desire for such an experience can lead to apparent deep disappointment or misunderstanding in its absence. Working with this feeling of apparent disappointment or misunderstanding or other relatively undesirable results is a key element of integration and harm reduction in entheogenic psychotherapy.

What are possible adverse entheogenic experiences and experiential proceedings in Entheogenic Psychotherapy like and how to manage them?

When entheogens are used, a person may have a difficult experience, such as panic, anxiety, and neurotic or psychotic-like reactions. Positive and sometimes recreational intentions and attentions have been found to predict a lower likelihood of a difficult experience, while higher doses have been associated with a higher prevalence of difficult and metaphysical and/or mystical experiences. Poorly managed environments and the personality trait of neuroticism and/or psychoticism predict challenging entheogenic experiences. In naturalistic settings, the intensity of difficult experiences is positively correlated with long-term beneficial effects. Most who have had a challenging entheogenic experience recognize a lasting positive effect on their well-being afterwards.

When discomfort arises during a challenging entheogenic experience, it can be helpful for the person to stay with the discomfort and keep their curiosity open, without prejudice or preconceptions about what is arising. This is best conveyed through the experiential proceedings technique, which is characterized by direct, nonjudgmental, and concrete awareness of bodily and sensory experience as it unfolds moment by moment. Staying with the experience of discomfort can make it easier to overcome the adverse reaction. A therapist is essential in advising the patient on how to calm down, how to stay safe during the experience, and ways to get through it.

What is Integration in Entheogenic Psychotherapy?

Entheogenic integration is a process in which the patient integrates the insights from their entheogenic experience into their life, and our work as therapists is designed to motivate, encourage, and prompt the patient to reveal understanding and integrate learning from that experience for a beneficial and healthy outcome. Thus, after the administration of entheogens, the patient must continue in therapy in order to provide him/her with the appropriate and necessary tools. Psychotherapy sessions that occur during and after an entheogenic experience and are intended to work with that experience are often called integration sessions; however, the integration process is grounded and reflected in what happens before, during, and after these sessions. Several considerations for this stage of the therapeutic encounter are covered here.

What does it mean to work with challenging experiences?

Patients and physicians or psychiatrists may simultaneously experience apprehension and anxiety when faced with difficult entheogenic experiences. Psychological and psychiatric symptoms after an entheogenic experience can take the form of anxiety, panic, depressed mood, flashbacks, etc. The distress may be accompanied by the patient's belief that these symptoms will persist for the rest of their lives. To physicians or psychiatrists, anxiety may appear to stem from interpreting psychological and psychiatric symptoms as early indicators of serious mental illness or loss of orientation to reality. To reassure the patient and avoid overreacting to anxiety and distress, clinicians should refrain from jumping to early conclusions while staying well informed about entheogens, their effects, and their risks.

What are the long-term mental-emotional health outcomes like?

Studies have been unable to establish a definite link between lifetime use of entheogens and unhealthy negative outcomes for long-term mental-emotional health. In most cases, the symptoms of anxiety and distress that follow the use of entheogens resolve without the development of a chronic psychiatric psychological disorder. Anxiety and distress symptoms do not necessarily block beneficial psychological outcomes, especially if appropriate safety measures are implemented to reduce the risk of possible psychological harm. However, after the duration of the pharmacological action of an entheogen has ended, symptoms such as insomnia, disorientation, anxiety, depression, flashbacks, among others, may persist, indicating that the patient needs more psychotherapeutic support after the entheogen session. Physicians or psychiatrists must distinguish between psychiatric psychological symptoms that can be managed by psychiatric psychological support and more severe reactions, such as a neurotic or psychotic episode due to entheogen use resulting from pre-existing vulnerabilities.

Possible dificult experiences in Entheogenic Psychotherapy

Algunos pacientes que buscan o han experimentado un encuentro negativo no saludable con enteógenos, cuando se usan fuera de los tratamientos adecuados clínicos y/o ceremoniales. Por ejemplo, con respecto al uso de algunos enteógenos, ciertos estados cognitivos (por ejemplo, preocupación y confusión) se correlacionan con experiencias adversas memorables vinculadas a sentimientos de incomodidad, vulnerabilidad y miedo. Las personas que usan algunos enteógenos han informado que reviven recuerdos de eventos pasados y, por lo tanto, pueden estar en riesgo de volver a traumatizarse si estos eventos pasados fueron de naturaleza traumática. Los médicos psiquiatras deben asegurar a los pacientes que otros se han encontrado con experiencias similares y se han recuperado de ellas. Tales seguridades contribuyen a la normalización de experiencias difíciles y reducen la ansiedad y angustia asociada. Cuando la intensidad de la experiencia ha disminuido de tal manera que el paciente puede entablar un diálogo con seguridad, el médico psiquiatra puede facilitar la exploración del significado y sentido de la experiencia.

In our integration and harm reduction therapy with entheogens, the importance of a difficult or traumatic experience and the patient's related perceptions are validated, receiving them with empathy and compassion; a patient should not be blamed or made to feel guilty for their difficult experience. It should also be recognized that as patients develop new meanings and personal senses or understanding of themselves and their interpersonal relationships, they may experience increased anxiety and distress and, at the same time, decreased experiential avoidance. By encountering psychological and psychiatric content previously avoided through the use of entheogens, patients may begin to realize what preceded their avoidance. These realizations must be incorporated into the integration and harm reduction process.

How to address possible anxiety and distress in Entheogenic Psychotherapy?

Our work offers a well-developed framework for understanding the experience and process of anxiety and distress, and its language is used here for this purpose. In this conceptualization, the anxiety or distress that can occur during a difficult encounter with entheogens can be equated with instances of outright fear. People may engage in experiential avoidance by attempting to control the entheogenic experience or to avoid some of the psychological psychiatric content of the experience, resulting in anxiety, distress, or psychological harm. Recognition and acceptance, rather than experiential avoidance, are intended to increase mental-emotional flexibility, or the ability to contact the present moment more fully as a conscious being, and to change or persist in behaviour when doing so serves worthwhile healthy ends. Low levels of mental-emotional flexibility are associated with higher rates of psychopathology and lower quality of life in general. Entheogenic integration, including with regard to fear reactions, can be helpful in increasing mental-emotional flexibility. By conceptualizing mental-emotional flexibility as a component of integration, fear can be addressed by examining it in detail and subsequently encouraging and motivating acceptance and awareness of feelings, emotions, or thoughts underlying fear reactions.

It should be noted that there are distinguishable meanings in the fear experienced during an encounter with entheogens. Aspects of the entheogenic experience are not purely random and are a reflection of an individual's biopsychosocial, cultural, ethnic, religious, or spiritual factors. Fear, a form of psychiatric psychological content, can reflect a person's biographical history and desires. Psychiatric psychological content is also shaped by individual mentality (set), as well as physical and cultural environmental influences (setting). In an entheogenic experience, anxiety and distress can be amplified into intense fear or panic, paranoia, or a loose connection with reality. Unhealthy or traumatic negative experiences may be related to the amplification of an individual's unwanted thoughts, feelings, or autobiographical memories. The amplification of anxiety and distress triggers experiential avoidance and sometimes a biological reductionist view in which the patient attributes their anxiety and distress to entheogens rather than to an entheogen-individual interaction or the interaction between the entheogen, one's mental-emotional state and life circumstances.

Many people, particularly in the absence of adequate preparation, find it difficult to understand or communicate their entheogenic experiences, and may not realize the potential of therapy to assist in the organization and transformation of these experiences. This gives space for us as integration and harm reduction therapists in holistic transcultural transpersonal integral entheogenic psychotherapy to help promote learning from the entheogenic experience and its integration into the circumstances of lived life. This involves actively and dynamically engaging with the patient to help them understand why the supposedly negative experience arose and how they can grow from it.

What is the dissolution of the ego in Entheogenic Psychotherapy?

Entheogens trigger cognitive phenomena such as ego dissolution and ontological shock, which can incite or exacerbate fear responses. Ego dissolution is defined as “the experience of a compromised sense of self” while ontological shock involves being forced to abruptly change one's worldview. The impact of these phenomena can be understood in terms of an interaction between the entheogen and individual circumstances, as well as the environment and the dose of the entheogen. Consequently, attention should be paid to this interaction, regardless of whether the patient reports that the experience was helpful or frightening, because these phenomena can occur abruptly, be disorienting, and result in a need for comprehensive holistic integral transcultural transpersonal psychotherapeutic support.

What is increased sensitivity in Entheogenic Psychotherapy?

If the negative response to stress and tension is conceptualized within frameworks, individuals can be viewed as adopting inflexible mental-emotional processes to avoid discomfort within certain contexts. This is somewhat similar to the psychodynamic practice of adopting ego defenses or defense mechanisms as a function of individual adaptation to one's environment. In each case, the psychopathology results, in part, from the overuse or rigid application of certain processes and a lack of mental-emotional flexibility. Entheogens can help people become aware of the ways they have historically coped with stressors and tensors in their environment and how they have suffered from mental-emotional inflexibility that has interfered with their desire to live life openly and with healthy values.

Entheogens increase mental-emotional flexibility, making people feel more open and less evasive by activating the processes of mindfulness, concentration, acceptance, commitment and behavioural change that are fundamental to the different frameworks. Mental-emotional states become more available, when previously they may have been protected by a psychiatric psychological defensiveness. However, as defensiveness is reduced, these new feelings of vulnerability and sensitivity can lead to increased fear and anxiety, which requires comprehensive holistic integral transcultural transpersonal psychotherapeutic assistance to navigate. Constructing meaning and purpose from the entheogenic experience is to aid in moving through the period of greatest vulnerability that occurs during the developmental process.

What is the process of Unfolding?

The unfolding process, a concept borrowed from humanistic psychology, denoting the ongoing unraveling of insights about oneself and one's relationships after an entheogenic experience, which may take place over the course of weeks, months, or years, is described by two ways or types of deployment processes. In sequential or horizontal deployment, new personal meanings develop progressively over time, with each meaning building on earlier meanings. In the vertical unfolding new and radical personal meanings emerge extemporaneously, along with the subjective experience of a greater depth of reality. Due to the continuous search for the construction of meaning and the propensity for unexpected results after an entheogenic experience, both unfolding processes are essential to understand the subjective experience of the sequelae of entheogenic use.

During deployment, the manifestation and intensity of symptoms can fluctuate in waves, presenting simultaneously as one of the most difficult stages of the therapeutic process. After the acute effects of the entheogen have worn off, patients may experience relative vulnerability, sadness, anger, etc. They may also experience mental-emotional states/body awareness in which they experience vague feelings or meanings about difficult events that they cannot fully articulate or understand. Therefore, it is appropriate that, during these unfolding processes, people turn to the integration and harm reduction psychotherapist in entheogenic psychotherapy in search of greater understanding and integration of their experience. The integration and harm reduction therapist assists the patient to work through the developmental process by helping to focus inward, making implicitly felt meanings explicit, addressing stress, tension, anxiety, and physiological distress, and fostering the development of flexible mental-emotional coping skills.

The unfolding process coincides with the concept of mental-emotional flexibility in different therapeutic models and, therefore, can be interpreted from a contextual behavioural perspective. Thus, our psychotherapeutic job is to ensure the expansion of patients' consciousness by reducing experiential avoidance or attempts to change unwanted affective responses. Therapeutic deployment involves observing and accepting experiences and affective responses, allowing experiences to arise and pass, and extends beyond intellectual analysis in the search to highlight valuable meanings. During the process, it can be useful to pay special attention to the body and the use of various somatic therapies.

What does the Spiritual Bypass consist of?

People apparently disappointed with the result of entheogen use may seek additional entheogenic experiences by either taking a higher dose or a different entheogen. Psychiatrists need to be aware of the possibility of spiritual bypass: engaging in spiritual practices to avoid pain and unresolved psychological distress. Stated another way, spiritual avoidance encompasses attempts to prematurely avoid or transcend basic human needs, feelings, emotions, and developmental tasks through activities aimed at self-healing or exploration, such as the use of entheogens, meditation, or search for metaphysical and/or mystical experiences. Since spiritual bypass tends not to include processes such as recogmition and acceptance and raising of consciousness, it presents openings for mental-emotional inflexibility and thus interferes with therapeutic progress.

Why is body awareness important in Entheogenic Psychotherapy?

It is helpful to recognize the experience of mental-emotional difficulties in terms of tension and stress felt in the body. As such, the incorporation and integration of an entheogenic experience implies the incorporation of somatic work. Somatic interventions increase awareness of sensory experiences and understanding of the relationship between physical states and psychological or mental-emotional content. The somatic work in our holistic integral transcultural transpersonal psychotherapy focuses on a bottom-up approach in which attention is paid to internal and external bodily sensations, as well as automatic responses to tension and stress, allowing patients to process and secure their mental-emotional and physiological responses without judging or overemphasizing the cognitive aspects of anxiety and possible psychological distress.

The therapist educates the patient about the importance of activities related to the body and motivates and encourages them to carry out different practices outside of psychotherapy, that is, patients can explore actions that promote body awareness, relaxation and body commitment, such as yoga, martial arts, grounding exercises, and mindfulness and concentration practices. Body awareness can also be achieved through sustained attention to the breath during meditation called Pranayama. Body-related activities have been repeatedly shown to correlate with mental-emotional well-being and increased body awareness.

What is the period of Glow or Twilight Luminescence in Entheogenic Psychotherapy?

Some people report a positive glow or luminescence experience after an entheogenic experience, which may include elevated mood, mental-emotional flexibility, openness, or mindfulness. This may be related to a period of increased neuroplasticity or a neuroplastic window after experiencing the effects of an entheogen. During this period, cognition and behaviour may be more susceptible to the influence of new knowledge acquired by the person. Therefore, the recovery period can allow patients to explore new behaviours and ways of thinking and to maintain long-term benefits after the development process.

How is sudden or abrupt well-being handled in a healthy way in entheogenic psychotherapys?

After an entheogenic experience, patients can be highly motivated to make major life changes. We as therapists provide the appropriate and necessary guidance to the patient so that he can evaluate the consequences of the decisions that, ultimately, may be useful to the patient. In addition, rapid changes in behaviour or sudden well-being can confuse or unsettle family members and the patient's social network, especially if some of them are not ready to accept the patient's new way of being. When this occurs, it can be helpful to apply a family systems perspective, in which there is a family tendency to maintain balance and homeostasis that is threatened when one family member experiences rapid improvement and change. This can contribute to particularly dramatic imbalances in the family system. We as therapists can help patients navigate family dynamics so that a new homeostasis is achieved; one that supports the positive and constructive changes of the patient.

What are the Tools to maintain the benefits in Entheogenic Psychotherapy?

The process of constructing meaning from entheogenic experiences is not isolated from the therapy environment. It is our responsibility as therapists to motivate, encourage, and prompt the patient to engage in activities that help maintain focus on the entheogenic experience and resulting insights. Such activities could include journaling, meditation, yoga, pranayama, mantras, martial arts, artistic expression such as music, painting, sculpture, and any other activity that helps to transfer the awareness gained through the entheogenic experience from an intellectual framework to a comprehensive holistic integral transcultural transpersonal framework that incorporates one's being. This method of entheogenic integration extension ensures that experiences are not a fleeting, momentary state, but materialize to facilitate long-term change.

Ampliar la integración también implica incorporar los conocimientos adquiridos a partir de las experiencias enteógenas y la terapia de integración y de reducción de daño en psicoterapia enteógena de acuerdo con los valores y objetivos propios. En algunos casos, los pacientes se darán cuenta de la necesidad de abordar traumas pasados o conflictos psicológicos en curso y, por lo tanto, buscarán una mayor estructura y tratamiento en otra forma de terapia especializada o intensiva. Para las personas que luchan con los conflictos interpersonales y la falta de apoyo, esto puede requerir la búsqueda de nuevas vías de apoyo y la expansión de la propia familia y/o comunidad. Las personas también pueden beneficiarse de los cambios en el ámbito de la vida diaria, como el ajuste de una carrera profesional, la dieta o los arreglos de vivienda para satisfacer mejor sus necesidades. La gama completa de posibilidades de actividades que amplían la integración es un proceso continuo y progresivo, tanto para el paciente como el terapeuta. Por lo que, nosotros como terapeutas brindamos las recomendaciones específicas, adecuadas y necesarias para el síntoma o el contexto, o, en otras palabras, adaptadas a las dificultades, conflictos y preocupaciones del paciente.

Community Reconnection in Entheogenic Psychotherapy

The attention and care of mental-emotional health through holistic integral transcultural transpersonal entheogenic psychotherapy, facilitates, above all, the renewal and recirculation of human resources. Entheogens have a documented ability to promote connection, and the shift from disconnection to connection represents a key mechanism in the healing process. We take advantage of this change by (re)connecting patients with social, economic and community systems, contributing to individual healing and the revitalization of the systems themselves.

Our treatment enacts a suitable and healthy place for the patient, as well as meetings where members can participate in a variety of personal-community healing and development activities, in addition to entheogenic psychotherapy. Explicit reconnection activities for those who have undergone therapy include group integration sessions as well as community reintegration programs.