This is a transcript of the interview featured in episode 90 of Adventures Through The Mind podcast.

The vocal modulation sued to protect the identity of the guest made some audio hard to understand. After it was requested multiple times by various listeners to have a transcript made, I put the word out for funding support to have this transcript made.

I gratefully announce that multiple people helped out, including Ian C, Samuel E, Lindsay C, and most especially, Hasan D, whose lavish generosity and support of this transcript paid essentially the entire cost of the transcript ($150 CAD). On behalf of everyone who will benefit from reading this transcript, HUGE THANKS TO HASAN!

The text here is mostly verbatim [pardon our poor grammar at times], although some changes were made for readability. Also, some parts were unable to be transcribed because of issues in connection during the skype call making it impossible to know what was said.

Enjoy.


Listen To Episode 90 of Adventures Through The Mind

James W. Jesso: Pikachu, Tooth Fairy, and Jewels, welcome to “Adventures Through The Mind.”

We’ve had a little bit of a hard run getting set up for today. We are months into the process of planning this. Why don’t we start off with a general question that’s going to go to each of you?

What exactly do you do? What kind of therapy are you providing? Is directive or nondirective? Is it more in a shamanic camp? Do you have one or two people with you? What substances are you using?

Tooth Fairy: James, I’m going to answer your question in an unorthodox way. What I’m providing for people is care from my heart. There are a lot of techniques I use to do that. Ultimately, what I’m providing is presence and care from my heart. That’s how I answer that question. Outside of my psychedelic medicine, I do somatic relational trauma-informed consulting. When I do psychedelic therapy, I use MDMA, 3-MMC, and now I’ve introduced psilocybin as well. I could probably talk long and hard about how I do that, but to me, the essence of it is being in a relationship, being moment to moment, coming from the heart and connecting with human beings, meeting a person where they’re at, and meeting them with everything that comes on. Polylegal theory is a very important umbrella.

Jewels: Maybe I’ll hop in next. Sound good here?

James: Yup, go ahead.

Jewels: I’ve been a counselor for over thirty years. When I found psychedelics, I was so impressed by how effective they are. I agree with the tenant that several sessions of psychedelics is worth two or three years of talk therapy. I also have found that using psychedelics gets into areas that talk therapy cannot get into. That default mode system is too well-established. I agree it’s about working with the heart and turning up for people and using a new technology that’s extremely effective.

Pikachu: I’ll go next here. I do therapy other than medicine work as well. I do see a lot of people for integration work. People have had their own practices or other experiences with various different medicines. Even the psychedelic work as well can work with existential work, transpersonal work, relational work in terms of the psychodynamic aspects, and some body-based work as well, so instead of just talk therapy, getting people to connect with their bodies and their deeper levels of processing. Definitely with medicine work, similar to what was said already, around companioning people and sometimes redoing particular attachment wounds that happened. That’s definitely one of my biases around why people come to any kind of therapy is because they need a reworking of what are some of their basic, core beliefs about themselves and how they can be in relationship to other people. The two medicines that I’ve worked with primarily are MDMA and psilocybin. I find also too that sometimes really good psychotherapy can be as effective as medicine work, but medicine work is itself a special category as well.

working with different substances.

James: You’re working with different substances. Tooth Fairy, you said MDMA, 3-MMC, which understandably have a fairly similar phenomenological effect on the person compared to, say, MDMA and psilocybin can be quite different. For each of you, when you work with different substances, does your methodology shift? How so for each one?

Tooth Fairy: Are you asking the methodology as you’re working with it, or how you get to choosing which one you’re working with?

James: That’s a great clarification. Answer both. Why don’t you start with how you get to the point of saying, “MDMA, not psilocybin,” or vice versa. After we do a round of that, then we’ll ask what the differences are in methodology during.

No, psychedelics are not magic bullets but are powerful agents to support the healing process.

Tooth Fairy: For me, it’s an intuitive process sometimes. I check in for months in advance. When I talk to clients, sometimes I might even say to them, “I don’t know if it’s going to be 3-MMC or MDMA,” about a week before. I’m always in communication with them. What it comes down to is what’s the most predominant mood that’s coming up right now? MDMA is a relational medicine. It’s a heart-based medicine. We all have relational wounds. We all have that at the core. When I’m focusing on a very specific trauma, one that has been overshadowing someone’s life for a long time, an encapsulated trauma, and it seems to affect everything else, then I go towards the 3-MMC. If there are secrets that have been locked so deep inside that they have not been able to share with anyone, I’ll go more towards the 3-MMC. That’s how I choose that.

With the psilocybin, I know psilocybin very well for myself over years of recreation use. In terms of working with it as a medicine, I started to work with a client with a — I’m going to say this loosely — an eating disorder. It’s never an eating disorder. It’s just called that. Really, it’s deep trauma in the womb. I decided on psilocybin with her. It’s so hard to articulate why, James. I had a sense that we needed to go very deep internally to a holding place, a place where she could experience, physically, the shame that has overshadowed her entire life. It’s hard to actually say why. These are speculations. These are really just working with the medicine over time. I have to say that a lot of the times I go with my gut and a lot of contemplation and a lot of conversations back and forth with the client until one day I wake up and go, “It’s this one.” I say to them, “I’m going to say this word to you: ‘MDMA.’ How does that feel for you right now?” It’s the cocktail. It’s really a cocktail of how I get there. There are no hard/fast rules about it for me.

Jewels: I agree with the Tooth Fairy. My methodology is to meet with people at least three times before the session. More would be better. I like them to come in informed. I always ask them to do lots of reading, listen to podcasts, yours included. The methodology is more of a consensus rather than me saying — I will give advice. I will say, “My sense is MDMA is a better one for you rather than psilocybin,” but I like it to be a consensus. One of the differences I find between MDMA and psilocybin is MDMA or 3-MMC is so excellent for trauma. It’s like a laser. It goes right in to where people need to be.

Psilocybin I find to be a more integrative process. For transpersonal kinds of explorations, I would definitely say psilocybin might be a better choice. The differences, what I notice is I call things like psilocybin embodied molecules. My sense is there’s a wisdom there that is not necessarily there with the MDMA molecule. I talk to people about that as well.

Tooth Fairy: I wanted to say that if someone’s coming to me for some ecstatic experience or they want to have some big, incredible insight, that, to me, is a little red flag. That is when I say, “Let’s actually take a look. What’s at the root of you not wanting to experience what’s actually happening for you?” I wanted to put that in there. I’ve actually dissuaded some people from people from doing psilocybin, a client with bipolar because I actually wanted to get down to what was happening for him in relationship with his family. I worked with MDMA. I wanted to toss that in while I remembered.

Jewels: It’s often a good introduction. I will absolutely agree with you on that. I see 3-MMC as clearing the way and very good for biographical material.

Pikachu: The only thing that I would add, probably, is that a client’s history, if they’re novice in terms of their own use, that might be part of the conversation around expectations. Then also for MDMA, the physiological contraindications, particularly if someone has any kind of cardiovascular, heart issues, anything like that I would really caution. If there’s any other sort of health issue or anything like that too, sometimes that can be a factor around even length of time, how long things last. I’d agree it’s a collaborative decision-making of coming down to which medicine.

How the style of therapy differs depending on the substance used.

James: Moving into the next question, it seems like what we’re talking about here is a pretty clear define somewhere between MDMA and psilocybin, the entactogens versus the classical psychedelics. How is it different for you in how you show up, in how you facilitate the actual therapeutic session during the drug session?

Tooth Fairy: First of all, I show up. [laughs] I show up so completely for anything that I’m working with. Because I’ve facilitated more with MDMA and 3-MMC, I find with the MDMA and 3-MMC there’s a lot of real focused working. For me, it’s a focused work period, really listening to each moment that’s being dropped and interacting with that. There’s a lot of interaction that way for me. Also, really paying attention to when a client is going internal and giving space for that client to go internal. And just in those gentlest moments to check in with the client to see if they want to come back out and work through something or complete something. I have found it more interactive, the 3-MMC and MDMA, than psilocybin.

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What I’ve found really interesting in the times that I’ve worked with psilocybin with a client is the amount of times that I’ve actually begun to experience what they were experiencing. For example, this client that I worked with who was really marinating in shame, had so much shame in her body that she could not even hold it, when I was working with her on psilocybin, it came into my body. I spontaneously began to shake. I’d never had that experience before. I wasn’t afraid of it. I said to her, “I’m not afraid of what’s happening right now. I’m going to help your body process some of this.” The twice that I’ve worked with her, I’ve actually taken on some of what she was experiencing to help the load. I found that very interesting. I’ve never experienced anything like that. I’d heard about it before. Both are very somatic-level work for me, but that had a real experience of sharing the load and letting her see it.

Jewels: I’ve had that experience as well, Tooth Fairy. I find showing up for both of those, I’m often on a very similar journey as they are. We share afterwards. Often, we have had similar experiences. To go back to your question, James. As a psychedelic psychotherapist, I have noticed that those are definitely different. They do need different kinds of support. The empathogens, because they often, especially in the descent, have a speaking-ness to them, I find I have to encourage people to say interior as long as they can. Sometimes just that because of the speediness of the substance, they start talking too soon. They want to talk and talk and talk. Sometimes I feel I need to say, “Can you be quiet a little bit longer? Stay in a little bit longer. We’ll have lots of time to integrate and process this.”

With the classical psychedelics, probably more of my support is somatically, holding them, always with permission. My methodology is maybe a little bit different, but of course turning up for whatever the need. Different people, their responses are so incredibly unique. People I think are going to be curling up in a blanket for two, three hours — that’s one response — all the way to people yelling and screaming for three or four hours and thrashing about. It’s a very, very unique response to both of those.

Pikachu: For me, knowing too that for MDMA there’s a lot more people wanting to have their own empathy directed towards the therapist, it’s more of an opportunity to have the level of relational work done as opposed to psilocybin where they’re in a little bit more of their own altered state or mystical experience or something that’s a real psychedelic state. That’s something I noticed around people staying inward a little bit more. There’s always a balance to how much do you encourage people to stay inward regardless of the medicine, go inward and really connect with themselves.

Sometimes people also want to connect with another human that’s supporting them there. There’s always a really big balance. Yes, the medicine is one piece, but even the combination of people that would show up, and therapist styles, and your amount of engaging versus waiting for the process to happen is a really big thing.

The other thing too that I think of as well is people have different decisions, their perceptions or decisions, around whether or not to partake in a smaller amount of the medicine themselves. That’s something that I have experimented with too. My decision is to be very clear and not be in any kind of medicine. I find just working with people in that place, it’s enough of an altered state for me, just companioning folks like that but I know that’s not everybody’s practice. I just thought of that while you guys were speaking.

Does The Therapist Take The Medicine as well as the client?

James: Is that something, Jewels or Tooth Fairy, you’d like to speak on, this concept of having a little bit to put yourself on the level. Is that something that you include in your practice? If so, or not, why?

Tooth Fairy: I do like to use a little bit when I’m working with a client. I find that I connect with them on that level. I find that clients generally like to know that they’re not alone on the medicine, the ones that I work with anyway. What that requires of me is that I keep doing my work throughout, my own work in between the medicine sessions so that I’m not doing my work in the medicine session. In a way, it disciplines me to make sure I’ve taken care of myself so that when I’m in the session stuff isn’t coming up for me on the medicine.

I do find that I personally can connect better with the client. I’ve had that feedback from clients towards me that they’ve found I’m really there with them and really understood what they were feeling, really got what they were sensing. Sometimes with psilocybin, I’ll do a microdose of it. That’s my personal way of working with it. That might change. Right now, that’s the way I like to do it. For me, it does deepen the experience. That’s what I was feeling. At the same time, I have no issue if the co-therapist that I’m working with doesn’t want to partake. I’ve worked in that way many times. I have no issue with that. It’s a beautiful mix that comes up.

Johns Hopkins psilocybin session room [source]
Jewels: It clearly is an individual choice of the therapist. I have tried both. Right now, what I go with is more the Grof model. I’ve been trained by people who were trained by Grof. I like to go in absolutely sober. I find I’m empathetic enough that I’m with them on the journey. There is a security that they know I’m clean and sober. That is an anchor for them in terms of if anything happened, they would know I would be there. I would be able to look after them and cope with whatever is coming up. As you, Tooth Fairy, sometimes my sitters like to take a little bit, like a microdose. I certainly don’t stop them. I understand that as a way as well.

The Structure Of Who’s In The Space?

James: I’m going to direct this next question– it’s directed towards all of you, but we’ll start with Pikachu because that feels like the right flow. You’ve mentioned now co-therapists and also, Jewels, you mentioned sitter.

What is the actual structure of people in the space? Is it you one-on-one? Is it you with a co-therapist? Is it you with a sitter? Who’s that sitter? Who’s that sitter to you? Who’s that sitter to the other person? If you could speak on the actual social structure of who is in the room, that’d be great.

Pikachu: My experiences have been quite different, mostly one-on-one. I really actually prefer the co-therapist model. There’s so much that can happen with that. People can bounce off two individuals supporting them, whether that’s same sex or different, male, female, or anything like that. This is not always possible in terms of what you have to put together with it too. The other thing that I’ve done is have an individual who is not partaking in the medicine and is not a therapist but is a supporter to the individual who is in the session, which can also be helpful. It depends on the individual dynamics and things like that, to have an additional person who’s been part of the prework and the preparation and things like that, one other person to be there for that individual as well. For sure, I’m still learning around how I want to do this and what works best and what not to do. If I could have my preference for the future, it would be two-therapist model because there’s a lot of potential around reworking some of these early family pieces.

Jewels: Two different models. Certainly ideally, two therapists is better because family systems can come up during therapy as well as archetypes, the male archetype, the female archetype. That can be a beautiful thing. Regression is something that often happens with psychedelics, so being able to have mom and dad there is absolutely wonderful. The drawback of that is expense. I have to pay for myself and a male sitter as well. If we were to go back to your first question, James, I do individual sitting and I also do group sessions as well. I like to start with individual. Then people, I will invite them to a group. Those dynamics are different. I love groups. There’s so much really great sharing that can go on before and after. During the ascent and peak period, people are pretty interior. I do both.

Tooth Fairy: Where I am in my life and in my thinking and my way of being, I’m not thinking about what’s best or what’s not best. I’m thinking about what might be optimal for a particular client, what might be optimal for a particular situation. That changes for me. I’m a bit more fluid about that right now. I have had extraordinary experiences with co-therapists where I thought, “I can’t wait to work with you again.” Pikachu and I have gotten to work together. That was an extraordinary experience that I would love to partake in again. I work very intuitively. Because I come from theater, I’ve often had to cast people in plays. I’ve had to pick the right person for the right part. For me, it’s a very similar process.

When I have client, I think, “What’s the right casting for this situation?” When I really follow that from a deep gut level, I think to myself, “How ‘bout these three people in a room right now together?” When I’m doing groups, I always do invite-only. It’s always clients that I’ve worked with. If I get a referral, I’m very, very careful and ask that person to work with me for a little bit. I cast groups. What I mean by that is I think about how this person would interact with this person with that other person to make a really strong cast, a cast of safety. Also, when I think about certain people that I work with, sometimes my sense is that this one particular client needs someone to be with them one-on-one, to have an experience of my full attention with them through the whole process because they’ve never had that kind of undivided attention.

For example, a woman that I was working with who was quite severely abused by her mother — she’s sixty-eight. It was her first experience of being in a room with a woman and not scared. She said, “This is the first time I’ve ever relaxed beside another human being.” I thought it would’ve blown her circuits to have three people in a room. It was enough. She knew. She said, “I just want you.” I said, “Thank you for letting me know.” I was letting her know about other awesome therapists that could join. She said, “I just want one person.” I said, “Great. Thank you for telling me what you want.”

There’s some other clients where I suggest — they might have very difficult experiences with fathers. I’ll suggest, “I wonder what it would be like for you to experience a gentle man.” Then I’ll call a colleague in another province and help fly them in if the client can afford it so they can have an experience with a gentle man. Again, it is really such an improvisation. It’s moment by moment feeling into it. It’s a casting. I don’t like to have rules about this. What’s good for one situation isn’t optimal for the next situation. The other thing is I lead group retreats, retreats for women, retreats for men. What I always love to do is have one man present for the women’s retreat and one woman, me, present for the men’s retreat. It’s a different dynamic. We always think, “Women’s retreat,” but what’s it like to have someone — we all have a male aspect; we all have a female aspect. We all have issues with our parents. It creates a very different dynamic to say, “Women’s retreat with a male in the room.”

Jewels: For clients who are resolving trauma, especially sexual trauma, male or female, if they’re ready for it — they’re not always ready it for it at the beginning. With permission to bring in all the same — sometimes it’s a woman who’s been abused by a man. To have a male sitter is an incredible experience for them. They can interact with that male sitter in different ways. It may be that they want to be held. It may be that they want to resist them somatically. I’ll set up a resisting posture. That might be what they need to do is yell and scream and really complete that trauma response of “No, no, no,” that they couldn’t do when they were six years old. I agree with you. I like your idea of casting, Tooth Fairy. That’s a lovely term.

Tooth Fairy: Thank you, Jewels. One thing I wanted to add, I had a client. This was a client through a friend. She specifically asked for my husband to be present in the room. I thought, “Fantastic. What a brilliant idea.” My husband is a very gentle, soft — does he do this work all the time? No. Has he experience in it? No. Has he sat with the medicine? Yes. Could I trust him to hold any space in the room? I said to him, “Don’t do anything. If she speaks to you, respond. I’m leading.” I was very clear with him on that. He sat there with his hands open, holding the most beautiful, compassionate space. That’s what she needed. This female client needed to know there was a male that was holding a compassionate space for her. He was moving his hands, moving energy. I trusted that. She trusted that. That was experience for her. I really love the idea that we’re discovering it as we go along, what is needed specifically for each session, each client. That might change from session to session for clients as well.

Jewels: I had a client specifically request my husband as well. He’s also a therapist. After pushing up and resisting and yelling at him for fifteen, twenty minutes, she finally relaxed. She took off her eyeshades. She said, “It’s a good thing I liked you.” [laughs] Because she knew him, she was able to do this.

Handling ‘bad trips’ or extreme panic/anxiety

James: I’m going to shift the conversation ever so slightly.

I’m going to ask Pikachu to start just because I’m noticing who’s getting to speak more. I’m wanting to definitely focus as much equality of opportunity to speak. I’ll start with you, Pikachu. What do you do when somebody goes into a heightened state? I don’t mean just high. I mean they’re in a high anxiety state. They’re in a state that in the recreational zone we might call “in a bad trip.”

Decomposing The Shadow: Lessons From The Psilocybin Mushroom is my first book and explores how to navigate and learn from uncomfortable psilocybin experiences.

What happens when somebody gets to a place where they’re now overwhelmed by panic or fear? Maybe they’re having an anxiety attack. Maybe they’re having a bolt response. They want to get the hell out of there. What do you do when things get really, really heightened? How do you help people calm down? What are some of the things that you’ve seen and that you’ve seen have helped?

Pikachu: One of the things you don’t do is tell them to calm the fuck down. [laughs] It’s interesting. There’s a couple things I want to speak a little bit. You know that I’ve worked lots in front of the more crisis response side of this. It’s really interesting because I haven’t found as many of these abreactions in the therapeutic side of it. There’s so much care taken in terms of structuring it and building it and getting to know somebody. So my answer is about the prework that needs to happen. I would say to people too if you’re ever looking to do this work with anyone, finding an underground therapist, and somebody says, “Great. Come tomorrow and we’ll do it,” I would run as fast as I could the other way. Somebody hasn’t taken the time to get to know you and what you’re coming in with and other things that might trigger you, the things that might be your sticky pieces that could cause potential escalation. I’ve talked to people in advance as well. My job is to make sure that you’re safe. Pieces of safety is not just psychologically safety, but physical safety. Do they live somewhere where there’s other people around? I’m going to make sure that they’re not going to leave the session, that there’s nothing around those safety constraints ahead of time.

Most people, they want to make the best use of it. If they’re somebody that starts to have a particular reaction, you work with it. You go with it. At other settings, at a festival or something like that where sometimes the behaviors, they’re just not conducive to the environment. If somebody needs to yell or scream, helping them to work that out on their own and allowing them, giving them permission sometimes too. If there’s some kind of physiological piece that’s happening and they’re getting really panicked or something like that, then I will offer being able to remember that they can go back into their body.

Sometimes really basic things like just remembering that they have a body, getting them to focus on their breath, or offering a hand, or something pretty small can go a long way. The other piece that I think is really important is providing that scaffolding around them where no matter what happens, I’m taking care of myself so whatever they need to process through, I’m good with. I’m not going to tell you to shush. I’m not going to tell you that you can’t do this thing, within reason. Whatever it is, I’m there for you. Let’s play around with that and use this as an opportunity because obviously it’s something that needs to move up and out.

Jewels: I agree with you that the best way to deal with what you were calling “bad trips,” James, is prevention first, set and setting, the therapeutic relationship, coming in informed, getting some idea of their attachment style, getting some idea of some attachment disruption. If trauma is the issue, where’s that trauma likely to take them? We’ve probably all got some strategies for preventing or rescuing from a bad trip. I find somatic support is one of the best ways to go and to catch that before it gets into the panic stage. If I see somebody starting to get distressed, I use a technique called healing touch, which is just holding them somatically in some key places along the body and just holding them with permission. That seems to work really well. I can say I’ve never had anybody go full into a bad trip yet. Set and setting and all those other things I was talking about that may help the therapeutic relationship.

Tooth Fairy: I agree with everything that Pikachu and Jewels says. What I teach all my clients whether they do the medicine work or not — I really love Sharon Stanley’s model around optimal arousal, high arousal, hyper-arousal, and low arousal, and hypo-arousal, and to teach clients how to stay not in the window of tolerance, but in optimal arousal even when we’re working. The clients I work with are very well-versed in that to begin with. I teach them those first signs of somatic arousal. We don’t make it bad. We learn how to stay within that to stay in the optimal arousal to process something. Things that I might use in sessions if I notice someone’s dissociating with their body, I’ve got sandbags. I’ve a beautiful little doorstop from Greece in the shape of a lamb that I might put on someone’s chest. There’s a lot of things in this room. I’ll ask them are they comfortable taking my hand. “Let’s hold on together.” What else might I use?

Toning is another one. I’ve noticed sometimes instead of going into hyper-arousal with screaming, which can sometimes — Sharon Stanley talks about this. We have to be very careful about when we complete responses because sometimes they can reinforce a hyper-arousal. Sometimes what I might do is ask a client to go into toning where we make a really nice tone together. It still has the same effect without going into that shrieking place. It teaches them how to self-regulate. That’s a huge one. I talk about that a lot when I’m working with clients, how you self-regulate, and in our work together, be mindful of that. I choose those completion responses very, very carefully, especially if I know the client has a more aggressive type pattern. I might get them to clench their hands and really slowly open up their fist rather than scream. I make invitations. Always I’ll make an invitation and say, “Are you up for trying this?” If it’s a no, then it’s a no.

Pikachu: One other thing to add in there is saying to people that, “Whatever happens for you –” I agree with not making it bad or making it a problem or something like that, to be moved around. […] I think a lot of people fear the lack of control or they’re going to lose control. Saying, “I’m going to be with you the whole time. I’m going to be here when you come back.” That’s totally okay. A lot of permission in being really regulated in my own body so I’m not sending any covert or overt discomforts, at the same time still being genuine, not being totally flat and so neutral that they don’t know what’s going too.

Tooth Fairy: Also, Pikachu, what’s really important, cuts in about your thing around that, is that, especially for MDMA, is if a client is picking up on something in you, to answer honestly is so important. When a client says, “I’m noticing that you might be nervous.” Answer that honestly and say, “Yeah, I am noticing that. Thank you for noticing,” so that they don’t feel like they’re crazy picking up on stuff. It’s so important to address what’s really happening in the relationship in the moment, which is a safety itself. So many times we as children may have asked our parents, “Are you angry with me? Are you disappointed? Is something wrong?” We got a “no,” and we knew there was something brewing under the surface.

Jewels: What you’re talking about, Tooth Fairy, goes along with somatic experiencing in terms of titration. There is this balance around how much trauma you can resolve or how much intensity you can experience without retraumatizing. That’s what we don’t want to do for sure. I know, James, you’ve talked about some traumatic psychedelic experiences. That is what we are trying to prevent. Maybe you touch into that intensity as much as you can handle in terms of integrating. If it’s becoming overwhelming, then all of us have techniques to help you titrate that. That’s a term which means you don’t have to do it all in one session. We can work on this particular intensity and integrating it. Maybe it’s going to take you a couple of years to really integrate what’s coming up for you right now.

“Dying” by Alex Grey ALEXGREY.COM

Providing Psychedelic psychotherapy Therapy To Dying People

James: I’m going to shift a little bit and ask a very pointed question about a specific type of client.

There’s a few big themes that’s coming up around what psychedelic therapy can help. One of them is trauma. Another one is depression. The other one is death-related existential anxiety and depression. My question for you is if any of you have worked with someone who’s in their dying time. What are some of the particular challenges that are presented in working with somebody who is going in to address that at that time in their life?

Pikachu: James, I really think that question is interesting because even though I’ve had some specialization in the death and dying themes, I haven’t specifically been a therapist where somebody who is at a later stage and getting closer to their — if they have something that’s more a palliative situation. It’s important work. Theoretically, I can tell you all about it and yet there’s those existential concerns for everybody. It calls to mind a lot of really important ethical considerations and again, the physiological potential qualifications if somebody has some pre-existing stuff as they’re moving towards the end of their life. In terms of my own personal experience, that’s all my specific work about that.

Jewels: I haven’t worked directly in a hospice sort of situation. I would absolutely love to. However, I will say that the death anxiety can come up for anyone in any session. Where I’ve seen most death anxiety is in young males. They’re not physically close to death, but it’s a huge concern for them. The psychedelic session will often take them through the death experience which, if they can travel through that, can be incredibly liberating.

Tooth Fairy: I haven’t worked with any clients with psychedelic medicine, certainly clients outside of psychedelic medicine who are dying. I’ve been at the deathbed of clients as they actually pass away, as they actually die. The one experience that I did have with a client who was a teen — he was boy. They’re still boys, he wasn’t a man yet. His mother was present for the session. He witnessed his own death. He dove down. He had trauma at birth where he nearly died. He actually orchestrated him going through his own death and coming up through it. He had such a deep fear of living. He was already quite addicted by the time he was sixteen. He dove down, met his death, and came up. It was like diving down in water and coming back up. At the end of this I said, “How did you do it?” He said, “I pushed through. I was able to push through that.” That was quite an extraordinary thing to witness. I’ve never witnessed it before, except my own death with ayahuasca. That was the first time I’d witnessed it with a client and someone so young. It probably brings up interesting ethical questions for everybody: a client in their teens, and the mother present, and also my husband was requested to be there again. That’s as close as I’ve gotten to it.

James: Let’s laser in. We’ll ask Jewels and Pikachu. Do you see any ethical concerns in the scenario that Tooth Fairy just mentioned in so far as supporting a teen? What is your ethics around that? What do you feel is appropriate? What do you feel might be too far out on the edge in so far as treating people who are not legally adults?

Jewels: My answer’s fairly simple, James. For me, I don’t work with minors with substances.

Pikachu: Mine would be: I haven’t. It’s interesting too because there’s always layers of ethical practice. Even between the three of us we have different backgrounds, different levels of training, whether or not we’re part of a governing body. We don’t talk about that stuff with [indiscernible] at the same time so it’s really interesting having your own level of ethics and what’s right. There’s also the world of somebody’s a mature minor. If they have the full ability to make decisions around their own care and if a family member’s supporting it — unless you’re given the work through clinical trials or through some other really above-board way, all the stuff that we’re doing around this medicine work is — there’s still prohibition. Those levels of knowing that people have their own decisions around what’s right and what feels right.

It’s hard without a law in the underground therapist world. The balance between risk and reward, not just for the clients and what’s okay, but also for us individuals around making decisions or taking people on, does it feel right? If something happened and let’s say that shit hit the fan, will that person have enough trust in what you’re doing as a professional and that they wouldn’t look at raking you over the coals in whatever way, shape, or form that could be. It’s a question that’s on everybody’s mind all the time is around those risks. People make their own decisions. One of the biggest things is when you have an ethical dilemma, do you have some kind of a process in place to be able to make sure that you’re going through different steps to consider all the angles?

One of the things that I’m a huge fan of is making sure that we have networks and people to consult with because often times people are doing this work in isolation and really needing to make sure that we run things by each other or by our mentors or by our co-therapists or whatever too. That absolutely has to happen especially with the angle of this still not being — there’s no regulation around this work. People that are considering either having a session done or whether they’re looking at this as a profession, those pieces are constantly being thrown around. What’s right? What’s not? Guidelines. To really do your homework around how someone makes decisions, where the yes’s and the no’s are in an area that’s fraught with grayness.

Jewels: I have a clinical supervisor for this work. I also have mentors that I can check in with. I agree. We all have to hold ourselves to our own ethical accountability in how we work. I could see myself working with minors from a harm reduction perspective. If I was working with a teen who was going to take a psychedelic anyway, to at least provide a safe environment, set and setting, for that minor to work. Also I like the idea, Tooth Fairy, of having the parent involved. That’s a really interesting possibility as well.

Tooth Fairy: What this minor did say, he said, “I could never in a million years imagine working with this medicine outside of this situation.” He said, “I will never touch this outside of a therapeutic environment.” That’s how important it was to him. It took me a year to decide. His mother had been asking me for a year. We had him in deep consultation. Pikachu, you had said something really important. When Pikachu and I were working with a client presenting with bipolar, had had an episode two years ago, he had said, “How young is too young to work with this?” Pikachu, you said, “Someone can come in sixty years old and not ready to work with the medicine.” You can have a fifteen-year-old come in and be really prepared to work with the medicine. I would say less so because there’s a certain age at which it gets difficult for young adults to make deep connections. I’d spoken to a colleague of mine, a famous Canadian doctor, I told him about this. I spoke to him with permission. It’s a mutual client of ours. He said, “This boy did the kind of work that none of us could do under the medicine.” He was blown away by the work he did because his mind was very open to it.

Our circuits can get very tight and fused the older we get. It’s harder to get in there. There’s a benefit of being more mature to be able to integrate things, but there’s also a benefit of neuroplasticity at a younger age. It’s really, really important after the session to be really clear with clients, especially with MDMA, “Please do not smoke pot for at least a month.” That can interfere with your processing. I’ve noticed clients that have gone away. They smoked a joint in the evening. Their processing changes. It’s hard. That’s the thing. You make agreements. It doesn’t people are going to keep them. That’s another part of this whole subject that’s important to speak about. There’s only so much you can regulate and control. You have agreements, but people break agreements. It’s another fascinating part of this.

James: Pikachu, unless you really need to speak that, and please do, we only have about fifteen minutes left.

Pikachu: Nope. Good.

Practices and Perspectives on Integration

James: There’s so many amazing places that we can go. Each of you is such a wealth of experience and knowledge. What has come is what’s here now. Before we go, I feel like we would all be at a loss if I didn’t ask you about what your practices are and what your suggestions are for your clients in so far as integration. I want you to speak generally. If you have something to add, I’d love an addition to how you support people in integrating large spiritual type experiences when they don’t have a religious or spiritual foundation prior to that experience.

Pikachu: I’ll jump in here. One of the people that I see for integration reasons — maybe they’ve had an experience locally in their city of origin or they go down to somewhere in South America and have an ayahuasca or something like that and they need to unpack it when they get back. Integration’s interesting because I want to ask everyone, “What are we going to do for integration?” It depends. It totally depends on what’s come up for you in the session, how it went, what you’re open to, if it was something that was a new experience that they were trying to understand or from something that was a really personal piece like something with their own lived experience, family experience.

A big part of the integration is what are you going to do with this going forward, if there’s particular changes that you have to make, reminders of how you want to live your life. Maybe it’s something to do with your health or particular choices of how you deal with your body. Maybe it’s connections around your relationships, you need to go and speak to somebody that you haven’t spoken to for a while, or a change you want to make in the world. It’s so personal. The whole idea of it is what’s your own innate wisdom, your inner teacher, inner healer? If you have a belief in some sort of spiritual facet of the planet as a teacher or universal understanding or something like that, that’s a big one.

Knowing that integration doesn’t just happen the week after or month after. It can be years afterwards and knowing that it’s not a linear process. It can be nebulous too. Sometimes it’s the way that something sits in someone around how they embody something around themselves or regulation. Other times it’s specific goals that can be made. Oftentimes when people come away from a really profound experience, whether medicinal or not, there’s the idea of, “I have to do all these things. I have all this information.” It’s helping people manage some of those. Maybe you don’t have to change your whole life overnight. Let’s be realistic. Be gentle with yourself. Give yourself some time to digest it and process it and this evolving relationship with the information that can come out. That’s my perspective on integration.

Jewels: I believe that integration is so important. It’s at least, in my mind, eighty percent of what people get out of the whole experience. I always follow up with at least one integration phone call two to three days after the session. That’s an hour. I also invite them if they want more integration sessions, certainly we can book that. In terms of integration, I put out three general areas that they can think about. One is their work, their career, their creativity, if they’re involved in producing things. How is that going to change? How does the session maybe change that? Second area is relationships. Did things come up that they want to change in their relationships? The third area is spirituality, meaning significance.

For all those three I always like to bring the integration questions down to the “how” question. Mother Teresa said, “Start today. Use what you’ve got. Work with the people in front of you.” That’s often what I’ll put out there. If you were going to start today to make some changes that have come out of this session, what would that look like? That’s really coming down to earth, really grounding into everyday life. Are we going to be better people because of what has happened here?

Tooth Fairy: When I work with clients in integration, it takes on many different forms. For sure, there’s always the session the day after the medicine session. That’s necessary. I invite clients to write to me. I invite clients to text me, leave a short message. I will have phone calls with clients. For me, it’s fluid. It’s different with each client. Embodiment is really, really important, how to embody this lived experience. I remind clients that what happened together is a lived experience. In the integration session if they hit upon a sensitive, “Oh wow. I’ve never felt relaxed in front of another human being,” I’m going to say to them, “Can you recall what that feels like? Can you stop for a moment and can you take that into your body to feel that again?”

What we’re doing here is we’re creating new neural circuits. I tell them that’s so important. This is neuroplasticity. This is a new circuit. That’s really important, how to bring it into the body. I will repeat that many times with clients. One the greatest pieces of information that one of my great mentors told me — she’s passed away now — she moved her little finger like this, just imperceptibly tiny, tiny, tiny bit, and she said, “It takes one neural activity to do this than this.” I always remembered that. If a client can go out with one small window of opening, that to me is gold. I’ll say to them, “Notice. Keep noticing how you’re experiencing yourself in the world. Keep noticing how you’re experiencing other people.” That to me is gold.

I really try to manage expectations. A lot of people will, afterwards, say, “How come this hasn’t changed or that hasn’t changed?” I had two people actually say, “Why didn’t I experience ecstasy with the MDMA?” I say, “Because you weren’t at a party. We were here to work on your relational trauma.” I actually just got that text right before this. She had asked me why didn’t she experience ecstasy. I said, “That’s why. That wasn’t the purpose.” She’s still integrating that. She goes, “Can you remind me, revisit this, what we were revisiting?” I said, “It was your relational trauma.”

That’s really important to me to validate for people that every small experience is so important, owning your own level. One of the things that Gabor Maté said at the ayahuasca retreat, which is so invaluable, is that the mind will try in invalidate our experience. It will always try to invalidate our experience. I will tell people, “Your mind, at one point, may question what happened and if it had any validity. That can happen. Watch your mind. Notice it.”

With different people I’ll encourage — again, it’s an invitation to perhaps try tai chi or qi gong or restorative yoga, music. We haven’t mentioned music. Music plays a really big part both in the sessions for me and for integration. Sometimes I’ll notice that there’s a little piece that’s hanging from the medicine session in the integration day. I might pick a very important piece of classical music which I know stirs at the heartstrings. It’ll be about let’s bring our sadness back. Let’s actually feel the sadness and bring it back to the heart level so we can process it together. These are some of my ideas around integration.

James: Beautiful.

Jewels: We’ve all spoken to this about the importance of integration being subverbal. It doesn’t have to just be talking. It can be movement or art. That’s something that I like to do. People make images of what happened for them. We’re working at some deep levels that are maybe below the verbal kinds of understandings of what happened.

James: Excellent.

Pikachu: I want to add one really quick thing too. Finding if they’re going to be able to have some kind of meaningful integration is like if they can have an experience — this can be any life experience where we get to step outside of what we think we know and being able to say, “Wait a sec. I proceed through my life. I had to adjust and protect myself and learn how to be in the world because all these things have happened, but wait a sec. What if I got tricked and that kept me from living the full life that I wanted to?” When people can go, “What if I could have a number of options open to me? What if the way that I thought I was before isn’t really actually — maybe that’s a limitation.” Now you can integrate into so many possibilities that can be open for the future because you’re not hammered or bogged down by things in the past. I have those kinds of conversations with people often. Sometimes we didn’t realize we’d been in a particular structure that affects our ability to take things on or look at things in a different way until we get out of ourselves and then come back into ourselves again.

Tooth Fairy: One last sentence, I know you’re about to say something, James. People always say, “It was not the experience I wanted.” I say, “The experience you are having is what’s being revealed to you. How can we be with the experience that’s being revealed to us?”

Come over to reddit to join the discussion on this episode.

James: It’s almost like we just went through an iceberg field today, if that makes any sense. We saw some really great ice formations, but barely scratched the surface of what’s actually in the water there. Maybe reality willing, there will be another time that we’ll be able to go deeper. As it stands, I want to thank each of you for taking time out of your busy schedules to come and share your wisdom and your experience here with us at “Adventures Through The Mind” and also for doing what you’re doing despite the draconian limitations that have been placed on the medicines that we have spoke so positively about today.

Pikachu: Thank you for expressing interest in holding space for this conversation in such a beautiful way.

Tooth Fairy: Yes. Thanks for your work James.

James: Cheers. Extra thanks to Jewels who was the initiator of this whole idea. We would not have come together if she had not brought it up.

Jewels: Thanks, everyone. It’s really great listening to all of you. I always learn something coming together with other people like this.

James: And, cut.


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