Is psychedelic integration another wellness industry scam?
Introduction
The industries of talk-based therapy and anti-depressants have consistently failed to demonstrate significant benefits to mental health in trials. The life-coaching industry is similarly ridiculed with hypocrisy and fraudulent activity. With the impending psychedelic revolution in mental health treatments, people are starting to carve out niche job opportunities for themselves, like the psychedelic integration coach. Something needs to be done to ensure the failings of the life-coaching and psychotherapy industries do not transfer over to the field of psychedelics.
Regulatory bodies have not been able to keep up with the rapid expansion of the Wellness Industry. It has become a $4.2 Trillion global business. It “encompasses all activities which promote physical and mental wellbeing: from yoga to healthy eating, personal care and beauty, nutrition and weight-loss, meditation, spa retreats, workplace wellness, and wellness tourism” (Global Wellness Institute, 2018). Now cases of abuse and malpractice are growing with nowhere for victims to turn to and no one to remove unscrupulous practitioners from the industry. This essay will focus mainly on talk-based life coaching and psychotherapy services. It will examine why these industries need regulation and to set boundaries of who should deal with what kind of issue. It will also offer a counter-argument to those who insist that integration is mandatory.
Psychedelic integration is an amorphous concept that continues to evolve. Diament et al. (2021) consider it to be the process of “integrating unconscious material that was unearthed by the [psychedelic] experience into consciousness.” Most integration practices involve talk-based therapies. This type of therapy has consistently failed to demonstrate significant impacts on depression (Ross et al., 2019). While talking is still a valuable part of healing, ultimately, it should be judged on its outcomes against mental illness if it is to be given such an important place in mental health services.
Most life coaching and psychedelic integration coaches use Cognitive-Behavioural Therapy (CBT). This mental health tool focuses on talking about how to reframe a client’s thoughts to alleviate mental illness. This overreliance on talking is resonant with what Dr. Bia Labate said in her talk at the Harvard Divinity School. That integration has become an “excess of verbalization, rationalization, and control” (2021).
Talk therapy has been allowed to continue despite its lack of evidence for various reasons. In his New York Times, bestselling book, ‘Lost Connections’, Johan Hari (2018) exposed to the mainstream how ineffective anti-depressant medications are and the fraudulent activity that has led to their use. Hari explains how the clinical trial process is like taking a selfie. You can take 100 pictures of yourself and delete 99 if they don’t show you what you want. This process is what has happened with talk therapy and anti-depressant medication trials. In the US, for a medication to receive FDA approval, it only needs to have two studies that demonstrate a statistical significance. Khan and Brown’s (2012) umbrella review supports this notion. They concluded that “a number of recent articles have emphasized the inability of antidepressant medications to consistently demonstrate superiority to placebo pills. This phenomenon has sparked considerable concern and criticism from the popular media, clinicians, and researchers”. Hari’s book did not share how the same concerning activity has occurred with talk-based psychotherapy trials.
Research on psychotherapy’s effectiveness on depression has been overstated, according to a meta-analysis published in the Cambridge Journal of Medicine (Cuijpers et al., 2010). This study discovered that around 15 clinical trials had been hidden from the public because they showed that talk therapy had no benefits at all.
Masturbation feels good, but it does not produce a baby. Similarly, talk therapy feels good to some people, but it does not resolve mental illness in many people.
An article published in The Lancet reveals how:
Even for the most robust interventions in the most selected populations, such as CBT for panic, 30% of those completing the treatment are not better at the end. And for more challenging difficulties, such as eating disorders, fewer than 50% achieve full recovery, with overall deterioration rates of 5–10% for adults. (Wolpert, 2016)
We can deduce that perhaps some people do genuinely benefit from talking. These people then champion talking as a cure for all people when it is only some who receive positive effects. This is the same type of zeal that comes from those who insist integration of psychedelic ceremonies becomes mandatory.
The limitations of the scientific methods have created problems in mental health treatments. CBT is held up as the ‘gold standard’ of talk therapy. However, it is only called this because it is the easiest method to measure in clinical trials. The gold standard of therapy should be the method that provides the most effective reduction in symptoms, not what is easiest to study. This thinking is reminiscent of the Indian tale of the man who searches for his lost wallet at night under a lamppost, not because that is where he lost it but because that is where the light is best.
The victims of the Rwandan Genocide famously rejected this idea of forced talk therapy. In this instance, the United Nations sent in a group of Western psychotherapists to support the Rwandans. However, the Rwandans found the experience of talking about their painful experiences to strangers not only unhelpful but actually harmful. Eventually, they sent the therapists home. The Rwandans said they preferred being outside, in the sunlight, with their friends, dancing, and moving through their emotions (Hari, 2018).
Depression treatments might be similar to the discarded medical treatment of bloodletting. Research shows that depression goes away without treatment in 6 out of 10 people within six months and 8 out of 10 people within two years (Reynolds & Eastwood, 2019). Bloodletting survived for so long because it was in a closed feedback loop. The doctors would leech the blood of a sick patient, and if they got better, the doctor would credit the leeches. However, if the patient died, the doctor would declare that the patient was so sick that not even the miraculous leeches could save them. The talk therapy patient mistakenly attributes the reduction in their symptoms to the therapist when the symptoms would probably have gone away even without their presence. Or if they don’t improve, they are labeled ‘treatment-resistant.’ So rather than blaming the therapies for being ineffective, the medical system blames the patient.
The psychiatrist Dr. Thomas Szasz (2008) also believes that talk therapy is harmful to individuals and society. Szasz blamed Freud for creating a science built on abstractions that have been one of the biggest boosters of narcissism in history. By encouraging people to look inside for the causes of their dissatisfaction with life, Freud crippled people’s will to make changes in the world. Similarly, the life coach encourages wealthy people to spend money when they would be much better off spending on social issues. The term middle-class escapism has emerged to describe this group of people who would rather spend money on themselves than contribute to society.
The other reason is one that Szasz has been trying to highlight for decades. Freud and his colleagues were attempting to create a new industry and science so that they could be taken seriously by their medical doctor friends and create jobs for themselves. This is a problem that capitalist incentives create. For capitalism to survive, it has to keep devouring parts of our lives that used to be filled by friends and family. Rather than turning to a trusted friend during difficulties, they are encouraged to turn to a paid therapist. Rather than try to make a new group of friends, people will join a paid coaching group.
There have been no alternatives to talk therapy and anti-depressants in most healthcare systems, so it is in the system’s interest to support these practices. Rather than a doctor saying to their depressed patient that they cannot help, they can lie to that person and tell them there are effective treatments available.
Many people have spent a great deal of time, hard work, and money to become highly trained psychotherapists. It would be challenging for a psychotherapist to admit that they had made a mistake and that their life’s work was a waste of time. This may be one of the reasons that psychotherapists are known to be at an increased risk of suicide compared to other professions (Kleespies et al., 2011). It must be incredibly difficult for a psychotherapist to put all their efforts into helping their suffering clients and not be able to make any difference in their lives.
Whose interest is integration in? By claiming that integration is mandatory, it may be that the coach is trying to serve themselves. As Szasz accused Freud of creating jobs for him and his friends, the coaches might also be trying to create an industry out of nothing. On the back of the potential legalization of psychedelic treatments for depression, the therapist and coaches who fear they will be out of a job are beginning to manufacture a new industry for themselves. If psychedelic medicines live up to the hype as a treatment for mental health, then the psychotherapist faces a difficult decision. They can either stand in the way of progress as the Luddites did when the industrial revolution threatened their jobs. Or they can rebrand themselves as integration coaches and ensure that they still have a place at the end of the revolution of psychedelic treatments. Additionally, these coaches may be getting the chance to play out their messiah complexes and narcissistic needs to feel special and important.
One of the issues in the coaching industry is how the coaches encourage people to spend beyond their means (Hunt, 2022). People who seek coaching are often in a place of desperation, and there are plenty of coaches who are happy to prey on this. People with mental health issues who seek out psychedelic psychotherapy are likely to be in a similar position of desperation and vulnerability. Hence, regulations are vital to protect the vulnerable from these predatory capitalists. It is important that access to these treatments goes to the most vulnerable sections of society and that wealthy people do not clog up the system with phantasies of middle-class escapism and peak-experience hunting.
Mark Manson writes that coaching can often degrade into “delusional positive thinking” and that the whole system is like a “psychological pyramid scheme” which attracts only “the most desperate and gullible” (2016). Manson’s first comment is supported by Leichsenring et al. (2018), who found that CBT does not outperform a placebo in a real-life clinical setting for depression recovery. And in his second comment, he points out the tendency for people to start as coaching clients and end up becoming a coach themselves.
Manson’s comments are not just slanderous conjecture; they are literally true in one case. A Ponzi scheme was exposed in Colorado, where a class-action lawsuit was taken up against a coaching group that promised commission to trainees who enrolled other coaches in their programs (Spector, 2016). These coaches were accused of embezzling $20 million. This pyramid scheme dynamic is also common in the psychedelic sphere with many unfulfilled Westerners coming out of their plant medicine ceremonies declaring that they want to become shamans or therapists. However, once these people realize that becoming a legitimate therapist takes many years of hard study and diligent self-work they turn to coaching as a shortcut.
There is no oversight of coaches, and so people can conjure up elaborate names like mindset- coach, addiction coach, or health coach without any repercussions. There is also no one for a client to turn to when they have grievances with their coach. There is no licensing body that can strike off the coach when they are guilty of abuse or malpractice. An argument often used to counter this is that the market will weed out these bad actors. However, this is not the case. While this is purely anecdotal, I believe it is worth sharing. A family member of mine has been a victim of a coach’s predatory actions and yet this coach still continues to gain success in her industry. These stories of abuse will remain as stories as there is nowhere for the abused to report them. Most victims are struggling individuals without the means to take on the coaches legally. What avenues do they have? To take the coach to court at great expense with no promise of a return? To go to social media and ‘out’ this person? Very few credible options are available. If these incidents are happening in the life coaching industry, there is an even greater potential for harm in the psychedelic coaching industry. The risks of working with substances as powerful as psychedelics are going to amplify the potential for abuse by those working in the field.
Another problem is the refusal of wellness practitioners to remain within the boundaries of their training. It is very common for a yoga instructor to give nutritional advice or tell a client that their traumas can be healed through stretching. While there may be some truth to this, a 200-hour yoga training course is not sufficient to cover all the intricacies of human nutrition or mental illness.
The same situation happens with the life coach. In the state of California, a psychotherapist is required to have a master’s degree, a background check, pass an ethics exam, and accrue 3,000 hours of experience supervised by a licensed counselor (California Degree Guide, 2022). Plus, the psychotherapist is only licensed to work in their state. Compare to becoming an integration coach and one can see how problematic the coaching industry is. There are no restrictions on where a coach can work, and many coaching certifications can be acquired in a single weekend. The only barrier to entry is that insurers will not cover a coach unless they have some sort of certification. But again, there is no requirement that anyone needs to be insured to practice.
Many coaches delude themselves. They say they do not want to go through the intense study required of psychotherapists because they want to focus on clients’ futures and not delve into their past. Or that they don’t want to deal with trauma. During life coach training, the instructors tell the students that if they encounter a client who does have trauma or mental health issues, they should refer them to a licensed psychotherapist. If a life coach has no training in mental illness, how are they even going to spot it when they are confronted with it? Additionally, life coaches are usually struggling to find clients and recoup the vast investment that training schools require. Hence, the author has never heard of a coach turning away a paying client.
Further, the psychedelic integration coach is likely to be dealing with people who have just come out of extreme states of consciousness and be in delicate states. Hence, the importance of having thorough training becomes even more necessary.
There is a fair argument that the process of becoming a licensed therapist is too strenuous and that it restricts people who cannot afford this amount of money and time. And that in this new digital and global age, these kinds of barriers are overly prohibitive and ineffectual. Hence coaching has arisen to address these issues. The response to this argument might be the adage that ‘two wrongs don’t make a right.’ A better solution would be for both industries to look at reform. The psychotherapy industry could reduce the number of hours of clinical practice required, give more financial support to trainees in the form of grants, and create a nationwide or global regulatory body.
There is an institution called The International Coaching Federation (ICF) that is trying to regulate the coaching Industry but has thus far failed in its objective. When I was working as a life coach, I was a regulated member of the ICF but not once was I asked by a client for my credentials, nor did the ICF contact me to ensure I was practicing ethically.
There are also issues at the societal level relating to the pervasive stigma around mental health. Some still see mental illness as weakness or regard it as malingering. These stigmas often lead to people turning to life coaching when they actually need psychotherapy.
Thankfully, many of the integration coaches who are publicizing their work seem to have followed the familiar path of being let down by talk therapy and the medical system and turned to alternative therapies like breathwork, somatic therapies, meditation, arts, and movement. There are many integration coaches sharing their work in podcasts such as ‘Psychedelics Today’, ‘The Psychedelic Medicine Podcast with Dr. Lynn Morski’, and ‘Psychedelic Salon’. In the podcast episodes that featured integration coaches, all of them stressed the importance of these alternative therapies for integrating psychedelics.
Integration coach Liam Farquar (Psychedelics Today, 2021) expands upon why somatic therapies are superior to talk therapies for depression. Farquar explains that understanding the cause and effect of a person’s mental illness is nice but not necessary for healing. This echoes Dr Stanislav Grof’s (2018) statement that his “clients could give you lectures on their problems, but the problems don’t change”. For Grof, his clients were only able to see symptom reduction once they had been through one of his Holotropic breathwork ceremonies.
Diament et al. (2021)(2021) clarify that there are two aspects of integration practices that have emerged. The first is about maximizing what was taken from the ceremony. The second is about harm reduction in those who experience challenges after the ceremony.
One of the reasons for the emergence of the integration coach is the lack of support in Western communities for psychedelics. While indigenous communities have psychedelics as a part of everyday life, the Westerner does not. An indigenous person may be able to seek advice from their grandmother about how they dealt with their first difficult ayahuasca ceremony; the Westerner cannot. Hence having the support of a paid practitioner is filling this gap in Western culture.
A fundamental clash has been identified by Diament et al. (2021) between the capitalist worldview of individualism, consumerism, performance orientation, and what is experienced in psychedelic ceremonies. Returning to Western culture after being in such alien landscapes as jungle retreats can be jarring enough, even without the use of psychedelics. Hence, having the support of a therapist who knows how to navigate the difficulties of landing back could be useful. The irony in this situation is that the integration coaching industry has been created because of the capitalist incentives.
Suicidality is another frightening occurrence that Coder (2017) believes supports the presence of the integration specialist. She shares that while most people are fine, some people lose a part of themselves in the psychedelic experience. This splitting of the self is where suicidality may come in. Coder believes an effective integration process should include integrating split-off parts stuck in the liminal space between worlds.
Additionally, psychotic episodes do occur after psychedelic experiences. In these instances, the support of an expert mental health professional could be life-saving. These two realities are strong arguments for why integration should be conducted by licensed psychotherapists rather than coaches. As mentioned earlier, coaches have no training on what mental illness looks like and so they are unlikely to be able to spot the early signs of serious problems and are unlikely to have the required knowledge of how to support someone in this process when it is in full effect.
Coder (2017) believes that there is a misconception that the plants will do the work for you in the ceremony. Rather, it was more like the plant was teaching a class, and the student has to then go and put the lessons into practice. Coder also sees integration as a response to those who believe the answer to unresolved issues is more ceremonies. Coder and many in her circle became frustrated that whenever they spoke to their shaman about unresolved personal issues, they were told just to do more psychedelics. Coder found that by working with an integration coach of her own, she was able to move through her issues.
The post-psychedelic state is an incredible window of opportunity to make changes to one’s life. Several studies have found increases in neuroplasticity in the brain after psilocybin ingestion and increased Brain-Derived Neurotrophic Factor (BDNF) after Dimethyltrympatmine (DMT) use (Hutten, Nadia R. P. W. et al., 2021). This window does not stay open forever and hence having an integration expert can help to squeeze out as much benefit as possible in that short amount of time.
The idea that integration should be mandatory conflicts with many people’s experiences. There are some who are able to integrate their personal material without external support. There are people who find talking to a group of strangers stressful. There are people who also find listening to the experiences of others to be uncomfortable, boring, and frustrating.
The integration process could be analogous to getting fit with a personal trainer. Some exercisers will be able to go jogging and do push-ups on their own and reach their goals. While others need the support, motivation, and expertise of a paid and qualified personal trainer. The personal trainer can help the client to maximize their experience as well as avoid injuries. The difference is that in the fitness world, one does not say that personal training is mandatory for fitness.
Blending the work of highly trained professionals and life coaches might be a solution for those who want integration support. Mindbloom is a company that offers ketamine-assisted psychotherapy. Ketamine is already legal for this use in the US and UK. This company starts by having the client meet with a psychiatrist to ensure the client has no medical issues. Then, the client meets with a coach to set intentions and afterward to work on integration. If the coach has any concerns, they have close contact with and oversight from the Psychiatrist.
However, psychiatrists’ position within the scientific and medical models might constrain the benefits that psychedelics offer. Psychiatrists are medically-trained doctors who specialize in mental health. Psychedelics produce experiences beyond the explanations of the medical model. Because of this, there might be an urge for the psychiatrist to constrain the psychedelic experience. Psychotherapists do not have to limit themselves in this same way and may be more able to allow these mystical experiences to blossom.
Clearer boundaries need to be set between what is the work of the coach, the psychotherapist, and the psychiatrist. Perhaps this type of regulation will come from the companies offering psychedelic services rather than governments or regulatory bodies.
With this impending revolution in mental health treatments, there is a sense that some old institutions are in danger of falling apart. The psychotherapy industry could either be left behind if it does not find a place for psychedelic medicine and other upgraded therapies like breathwork, movement, and somatics. Or it may be devoured by the life coaching industry in the same way as the highly trained London Black Cab drivers were replaced by Uber. If this were to be the case, then the need for more stringent training and oversight of coaches would become more important. Perhaps, the addition of psychedelic medicine to the tool chest of the psychotherapist will have synergistic effects that enable talk therapy to show meaningful results for depression. A study comparing how the utility of integration coaching versus no coaching would be useful. Additionally, more research needs to be done to investigate the effectiveness of alternative therapies like breathwork, somatic therapies, and meditation for mental health and integration purposes.
References
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