Case Study: EMDR as a preparation and integration tool in psychedelic-assisted therapy

Abstract

This case study illustrates the use of Eye Movement Desensitisation and Reprocessing (EMDR) therapy as a tool for preparation and integration of non-ordinary states of consciousness. It provides an account of work from the field of psychedelic-assisted EMDR therapy (PsyA-EMDR) and explores how the eight phases can be adapted to optimise psychedelic healing. The client attended six preparatory EMDR sessions, a psilocybin treatment in the Netherlands, followed by six sessions of EMDR to facilitate integration of the psychological material that emerged at the retreat. Key themes of set (mindset) and setting, resourcing, working with the transpersonal content, and bridging into the psychedelic matrix are explored. The adaptive information processing (AIP) model is used to conceptualise the process throughout.

Full text

Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
Case Study: EMDR as a preparation and integration tool in
psychedelic-assisted therapy
Abstract
This case study illustrates the use of Eye Movement Desensitisation and Reprocessing (EMDR)
therapy as a tool for preparation and integration of non-ordinary states of consciousness. It
provides an account of work from the field of psychedelic-assisted EMDR therapy (PsyA-EMDR)
and explores how the eight phases can be adapted to optimise psychedelic healing. The client
attended six preparatory EMDR sessions, a psilocybin treatment in the Netherlands, followed by
six sessions of EMDR to facilitate integration of the psychological material that emerged at the
retreat. Key themes of set (mindset) and setting, resourcing, working with the transpersonal
content, and bridging into the psychedelic matrix are explored. The adaptive information
processing (AIP) model is used to conceptualise the process throughout.
Learning Objectives
Compelling evidence from the outcomes of recent clinical trials into psychedelic-assisted therapy
has sparked public interest (Carhart-Harris et al 2021, Cavarra et al 2022). It seems that we are
now facing a renaissance of the healing potential of psychedelics. Therapeutically, things have
moved on significantly since the first wave of psychedelic-assisted therapy techniques in the
1960s (Carhart & Goodwin 2017). During this 40-year hiatus, trauma informed practice has
revolutionised contemporary therapy practice (Van Der Kolk, 1989, Seigel 1999, Porges 2011,
Levine 2015).
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
EMDR has the potential to build an important bridge between psychedelic therapy and effective,
evidence-based, trauma informed practice. Legislative changes are already happening as these
compounds enter large scale, multi site Phase 3 clinical trials in clinical populations across the
world. Research into the efficacy of therapeutic modalities when working with psychedelic material
needs to keep up with this expanding field. Developing an EMDR protocol for psychedelic
preparation and integration is an unfolding process. Herein, we explore how the tools used by
EMDR practitioners merges with best practice in psychedelic preparation and integration therapy.
Psychedelic preparation and integration therapy has been informed by historic and contemporary
studies in psychedelic-assisted therapy (Reid & Papaspyrou, 2021), methods used at legal retreat
centres in South America (Ruffell et al 2021) and the Netherlands (Open Foundation, Netherlands,
- https://open-foundation.org/); evidence from practitioners working underground during and since
the hiatus (Jade, 2018, Bourzat 2019); and indigenous, shamanic practices (Harner 1992, Metzner
1998). Predominantly, the interventions utilised for this case study were a combination of the
standard (Shapiro 2001, Shapiro 2017) and attachment informed protocols (Parnell 2013) from
EMDR therapy along with psychoeducation about harm reduction (Gorman et al 2021) and
elements of the ‘Accept, Connect, Embody’ (ACE) model (Watts & Luoma, 2020) developed in
early psilocybin trials (Carhart-Harris et al 2021)).
Introduction
This 32-year-old client presented with a problematic reaction to a relationship breakdown,
manifesting as an intense fear of abandonment. The client reported numerous Adverse Childhood
Experiences (Anda et al., 2008). They had previously attended long term (7 years) traditional
narrative-based psychotherapy but had become frustrated at “not covering any new ground”. This
intervention was part of their “ongoing personal development”. This case study will describe how
Eye Movement Desensitization and Reprocessing (EMDR) was applied to preparation and
integration therapy for their psychedelic treatment at a private retreat centre in the Netherlands.
Psychedelics are a Class A restricted substance in the UK (Misuse of Drugs Act; 1971). To ensure
legislative compliance, the client made arrangements with a Netherlands (NL) retreat centre as a
private provider of the psychedelic component of this work. The centre offered a group
psychedelic experience combined with preparation and community-based integration sessions.
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
This was accessed in addition to the EMDR intervention. The psychedelic sessions were held by
English speaking guides, all of whom had therapeutic training (Psychotherapists, Psychologists,
Psychiatrists). The psychoactive medicine used was 33g of fresh (ground) psylocibin ‘High
Hawaiian’ mushroom truffles (legal in NL) served as a tea infusion. Ginger was added to the tea to
help with nausea. As is customary, participants met in a shop in Amsterdam where they
purchased their own truffles in advance.
This case study describes the process of an in-depth clinical interview to determine case
dynamics, and formulation and diagnosis of the real issues, as well as the applied Attachment
Informed (AI) EMDR Protocol, and treatment outcomes and follow-up. Itwill conclude with
reflections on the success of the intervention, wider issues relating to psychedelic-assisted
therapy, and legislative limitations.
This case study was co-created with the client to ensure they were satisfied with the volume of
detail/anonymity and that it was true representation of their experience. They were given the final
draft to read and the opportunity to edit before submitting to the journal. As is customary in a
private practice, subjective ratings and qualitative material are the primary means of assessment.
In this case material, additional psychometric measurements were not taken; an evaluation of
which will be addressed within the discussion section.
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
This case study provides an illustrative example of how an underwhelming psychedelic experience
can be worked with using EMDR to elicit meaningful therapeutic change.
Course of Therapy
Phase 1: History taking
During the detailed history taking, the following adverse experiences were reported:
Prior to birth – Mother had ectopic pregnancy – surgery for removal.
Birth – hospital delivery. First live birth delivered. Post-natal depression.
Age 2 – sister born – post natal depression and maternal overwhelm.
Age 5 – Moved house. Client unhappy and unsettled by this.
Age 6 – Family dog died. Big impact on mother. Dog replaced with ‘bad’ puppy, contributing
to parental overwhelm.
Age 7 – Cousin (maternal) died in RTA. Mother emotionally absent.
Aged 7 – Mother initiated a new relationship online. Possibly in reaction to complex grief.
Aged 7 – Mother left the family to live with new partner in America.
Age 8 – Their school placement was based on their mother’s employment at the school. So,
they started at a new school, losing many attachments and friendships.
Age 8-14 – Various new partners introduced by their father. Pattern of broken attachments.
Age 12-14 – Peer attached, exhibiting many problematic antisocial behaviours.
Age 14 – Was told they were visiting their mother in America for a half term vacation but
upon arrival they were told that they would not return to the UK. Begged to come back and
returned for one month. Problematic behaviours continued and they were sent back to
America.
Age 15 – Younger sister joined them to live in America.
Now lives between both countries. Stays up to nine months in England, and six months in
America. They tend to live in impermanent accommodation.
The client chose EMDR alongside psychedelic assisted therapy after listening to a podcast by an
American therapist discussing the potential benefits of combining the approaches. After years of
talk therapy, they were interested in the neuroplastic potential of the brain on psychedelics. They
described their issues as “in my body” and “beyond talking”. In this piece of work, they wanted to
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
address the “physical as well as the biographical.” They were “desperate for change” and “single
and getting extremely triggered when dating”. Friends said they were showing “similar relational
patterns to childhood”.
Case Conceptualisation
From an AIP perspective, an emotionally absent mother and early disruption to the main
attachment relationship led to an internalised sense of self-defectiveness (Kohut, 1971). This was
compounded by the mother physically leaving, triggering further disruptions to their interpersonal
relationships (Knipe 2018) and further attachment rupture from unexpectedly relocating to
America. The feelings of abandonment triggered in response to their interpersonal relationships
as an adult appear to be rooted in these early relational traumas.
It is worth noting that numerous Adverse Childhood Experiences (Felitti et al., 1998) were
reported. It is widely accepted in the field of trauma that attachment severance during childhood
impacts the development of later patterns of attachment (Schore 2003, Schore 2008, Schore
2021, Siegel 2001, Cozolino 2014). Therefore, the attachment Informed (AI) EMDR approach was
chosen for this treatment.
Following the clinical interview, a treatment plan was agreed on:
Development of the therapeutic container
Psychoeducation and harm reduction / risk minimisation in preparation for the psychedelic
experience
Resource development and enhancement
Preparatory EMDR session based on current content to establish tolerance of the
psychedelic experience
Psychedelic session (external provider)
Integration session – free association narrative of the experience using BLS
Establishing target – radical acceptance of the emergent content (Watts, 2021)
Bridging from the ‘psychedelic matrix’ – image, emotion, body, belief
Attachment informed (AI) and Inter-generational (IG) interweaves (if necessary)
Link to the present
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
Build future resilience
NB – Sessions before the psychedelic experience will be referred to as Session - 6 to
Session -1. Sessions after the psychedelic experience will be referred to as Session +1 to
Session +6.
Phase 2 Preparation: Risk Minimalization and Resource Development
After our initial assessment, six preparation sessions were offered in advance of the retreat. These
were used to:
Develop the therapeutic container. This is necessary to contain a potentially overwhelming
psychedelic experience and develop confidence in supporting the client’s return to the ‘window of
tolerance’ (Seigel 1999). Breakthrough psychedelic experiences that include ego dissolution
(Nour et al., 2016) and full mystical emersion seem to have the most therapeutic benefit (Rucker
et al 2022). The removal of psychological defence mechanisms has the potential to destabilise the
client in the short term, so a robust therapeutic container and tools to enhance the window of
tolerance are essential.
Psychoeducation and risk reduction (harm minimalisation). Consideration of ‘Set and Setting’
are seen as good practice for robust and effective psychedelic preparation (Hubbard et al 1961,
Dalgarno & Shewan 2005, Read & Papaspyrou 2021). Clear, predefined expectations of the
‘Setting’ are essential. The client needs to have a clear understanding of the psychoactive drug
being used and a pre-agreed dose, along with group size, facilitator roles and group / facilitator
gender. The client should be confident that the space holders are suitably qualified. Ideally, the
group should also be offered community-based group preparation and integration sessions to
process the whole group experience. Combining horizontal (peer based) and vertical (medicalised)
models of care is seen as best practice in avoiding over medicalisation of healthcare provision
(Thomas 2008). Discussions should include how other participants processes may affect the
group experience. It could also be useful to develop an awareness of how group dynamics may
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
play into familiar family dynamics (Kettner et al 2001). The client is also encouraged to check that
the external provider has good credentials and is operating legally.
Developing the Set (mindset). Exercises using symbolism help to support and develop a
psychological mindset. Material from the psychedelic session may include (but is not limited to)
archetypal content such as animals, colours, shapes and human/non-human forms. Integration
therapy seeks to accommodate and assimilate meaning from the (often quite abstract)
psychological content. EMDR resourcing imagery exercises provide an opportunity to practice
working symbolically with such psychological content.
Additionally, establishing a clear intention can support and direct a psychedelic experience (Watts
2020). The client didn’t have a clear intention for this retreat during our -1 preparation session.
However, during the review of this case material, they later shared an excerpt from their personal
journal which detailed their intentions as to
“Show what is holding me back, Allow me to feel whole, worthy and good enough,
See what I need to see in relation to childhood/my mother wound and
See how I can best serve the world with the insights/gifts I receive.”
Resource development. A safe/calm place was established. Protective figures, nurturing figures
and a wise figure were installed using BLS following the AI-EMDR protocol. These were tested for
effectiveness and tolerance using content from a reactivation experience on a recent flight
between UK and America. Self-regulation and re-stabilisation into the window of tolerance was
established to be effective.
Tools and strategies. Rehearsal of phrases to overcome belief-blocking and looping such as
‘Trust, let go, be open’, ‘Lean in’ or ‘In and through’ were used as processing prompts during the
preparatory Phase-4 reprocessing abreactions (discussed later), along with traditional EMDR
prompts “notice that”, “feel that”, “go with that”. These mantras (widely attributed to psychedelic
veteran Bill Richards (Watts 2021)) are useful preparation for the psychedelic session. Resourcing
experiences of letting go and bravery were installed using BLS. The popular EMDR metaphor of
‘the tunnel’ was used to remind the client that ‘fastest way to get through difficult content is to put
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
your foot on the accelerator to get to the other side’. Journaling, which supports adaptive
information processing, was used as an adjunct to therapy. The client was encouraged to journal
throughout the course of treatment and keep a note of any new material that emerged in between
sessions. This information was then used in re-evaluation (Phase 8).
Phase 4 Re-processing – used as preparation for psychedelic dysregulation
An initial Phase 4 EMDR re-processing session was offered for one (-3) preparation session,
leaving the -2 and -1 sessions available for further containment if required. This ensured plenty of
opportunity for stabilisation immediately prior to the retreat. This preparatory Phase 4 session was
based on current content – the present context of the three-pronged approach (Shapiro 2008). It
was used to establish tolerance of emotionally intense material that may emerge in the
psychedelic session. It also served as a preparation for post-psychedelic EMDR integration
therapy. Emergent childhood content was bracketed off to avoid destabilisation.
Phase 3 Assessment: Treatment Goals
One week after the retreat, an initial EMDR integration session (described herein as Session +1)
allowed the experience to be communicated, forming a narrative. Free association of the
experience was supported using BLS (tapping). This served as a debrief as well as an
assessment of the emergent themes (Shapiro 2007). Care was taken to not edit or judge the
relevance of any material that came up. Psychedelic content can be viewed as a rare and valuable
insight into the usually deeply defended content of the deep psyche. Radical acceptance (Watts
2020) of any unconscious material reported is crucial.
In this case, the client described having a disappointing experience. They did not experience any
visionary material that is synonymous with a psychedelic experience. They described a harsh
inner critic judging them throughout, that they were “doing it wrong”. They reported somatic
experiences of discomfort in their jaw, neck, and lower body. They described how much time,
effort, and money they had invested in the experience and their deep sense of disappointment.
The high expectations set by the marketing and media around psychedelic-assisted therapy were
defended against by a shutting down of feeling; replaced by the emotional tone that they had
“done something wrong.”
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
Assessment
Themes of self-defectiveness that emerged during the psychedelic therapy session were explored
in the proceeding integration sessions using EMDR therapy. The thoughts and somatic sensations
triggered by the psilocybin were used as the starting point for the somatic bridge technique
(Watkins, 1971) to identify the corresponding maladaptively stored material that had emerged
(Browning, 1999). The somatic bridge landed on a memory of being “on a holiday in Italy with
other children, who had arranged a water balloon fight”. While the other children were setting up
the game, the client (age 5) had access to the water balloons and inquisitively began to play with
them, popping them in so doing. The other children found out and were angry at them and had told
them that they could not play. They described how they were “surprised to be still upset about it”
and that they had “not been able to stand up for themselves”. They had gone to their tent and
described how “no-one came to check that I was ok”. This highlights a potential attachment
wound, pre-dating the separation caused by the mother leaving. This appeared to be the
touchstone memory or ‘root node’ of the self-defectiveness memory network that we were
targeting (Shapiro 2001).
In this memory, the worst part was the boy in charge who told them that they “can’t play with them
anymore”. The emotion was feeling misunderstood, shame and fear, which was felt in the chest
and throat. The negative cognition was “I am unworthy/unlovable”. SUD were10. They described a
“constriction in the throat” and “not knowing what to say and so it’s best to not speak”. On
reprocessing, they described how it was “helpful to think about different perspectives” and had not
realised that they had “needed someone to be there to ask what was wrong.” This shows the
adaptive information emerging as the memory is reprocessed and the SUD reduced (Shapiro
2001).
Phases 4 – 8
As the memory was re-processed and integrated within the adaptive memory networks (Shapiro
2007, Hase 2017) the client indicated that they were “seeing parallels in being lonely and isolated”
elsewhere in their life. They described how they “keep friends at arm’s length” and that this “same
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
narrative is applied to lots of situations in my life”. This validated the choice of target because the
brain automatically made connections resulting in maladaptive interpersonal behaviours.
Psychoeducation around enactment was provided to consolidate the adaptive, metacognitive
(Flavell 1979) viewpoint that was naturally developing. Given what had been shared, reparative
attachment-informed interventions were conceptualised as appropriate to attempt to heal their
attachment deficits in the imaginal space (Parnell, 2013).
During the re-processing, another formative memory from age 8 was revealed. The paternal
grandmother, who was in a care giving role when the mother had left, verbally attacked the absent
mother, placing her as the “bad object” (Klein 1926). They identified that critical judgement had
since been internalised and they tend to “judge myself before others judge me”. Using a
reparative, inter-generational interweave, we explored how this ‘superego’ was ‘introjected’
through interactions with the grandmother (Freud 1924). Finding their origins in dated religious and
cultural practices, this was then processed using BLS. Imaginal interweaves were used to revisit
the parental alienation experiences. Providing resources, (nurturing and protective figures) to
support and patch over the deficits caused by these formative experiences, we directly addressed
the critical judgement of doing things wrong. One adaptive thought expressed was “in who’s eyes
is the wrongdoing?”. Once again, the target was incomplete and the session finished with the child
parts being taken forward in time to the present and settled into the preestablished calm place.
The SUD were4 but the client said they wanted to let the experience percolate. They agreed to
reach out for containment if required.
The theme of self-defectiveness kept emerging in the work, and each time a somatic bridge was
used to identify the corresponding maladaptively stored material. Once this network was
sufficiently re-processed using BLS, another theme of abandonment was revealed, which was re-
processed accordingly. Throughout this process, all the main traumas identified during the history
taking phases were addressed either directly with BLS or indirectly with imaginal re-scripting of
touchstone attachment experiences.
Eventually, adaptive thoughts of “doing things ‘wrong’ is other people’s stuff” were accompanied
by images of a “protective light bubble” and “lasers spreading out and zapping other people’s
judgements”. Expressions of “not letting it hook on me anymore” brought the SUD down to 0. We
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
revisited the different channels that had bridged from the core memory and integrated the new
adaptive material that naturally emerged using BLS. The protective light bubble appeared to
represent a strengthened ego and a new confidence in relationships. This can be conceptualised
from the adaptive information processing perspective and will be discussed later. The age-5 target
and psychedelic retreat target were cleared to a SUD of 0 and the validity of cognition (VoC) of “I
am loveable/worthy” was placed at 7. The positive cognition was installed, and body scans were
positive and adaptive for both.
Session +6 began with a re-evaluation of the target and review of Session +5. The shift of the
descriptor from “I am unworthy/unlovable” to gratitude with the SUD remaining at 0 indicated
target completion. They expressed a sense of gratitude for the retreat experience. On reflection,
they had “received the perfect medicine”. This was installed using BLS.
Robust and effective EMDR therapy requires a 3-pronged approach. Therefore, we took the
emergent material into a Future Template. They described how an ex-partner’s family member
discouraged them from having children together, saying that if they had children, they would likely
re-enact their own attachment experience and “leave their own child”. This triggered a core belief,
and they described how they had a “fear” about their capacity to be a parent. We bridged forwards
from this – image, emotion, somatic sensation, and belief – and BLS was applied. Eventually,
they processed to a place in time at the “end of my life”, with an image of them “being elderly and
not having had the experience of being a parent”. This fear superseded other people’s judgments.
On reprocessing using BLS, an image of future resilience emerged – a sense of being good
enough and working with whatever life brings. The protective bubble and lasers displacing other
peoples’ judgments also featured in the adaptive thoughts processed here. Once again, gratitude
featured and was tapped in. SUD remained 0, concluding this piece of work.
Review of Therapy and Follow-up
This person’s experience highlights the importance of addressing the preverbal, transpersonal,
and intergenerational content for robust EMDR target completion. Key features of this work will
likely generalise out into other aspects of our ongoing work, and it is for these reasons that
multiple sessions were required to fully address this specific target. This open-ended piece of work
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
continues, and the client intends to use legal psychedelic experiences alongside EMDR to deepen
the work we do.
Outcomes
In collaborative review of this case material, the client described how “EMDR allowed me to go
deeper and explore the associated memories that were connected to what came up in my
(psychedelic) trip”. EMDR “allowed me to experience the difficult feelings in my body and, as I
reexperienced it, it loosened its hold on me”. It was “like a glitch in my thinking and EMDR helped
me break out of it”.
Discussion
This client described how “lots of people look at it (psychedelics) as a silver bullet; you take it one
time and you are cured”. Their experience on the retreat moderates this view of psychedelics.
“After the retreat I was not fixed, but I set to work with the material”. They explained how “people
don’t realise the importance of the work that comes afterwards”. They gave an example of how
“one other retreat participant who had a similar experience to me says they didn’t get much out of
it...”, but that “I have had a change in perspective as a consequence of EMDR”. For this client, the
turning point can be framed using the AIP model. Through EMDR, the imagery of a protective
light bubble appeared to represent a strengthened ego and a new confidence in relationships
challenging the faulty cognition. This generalised out into other areas of our ongoing work
together and has impacted various aspects of their life – the details of which go beyond the remit
of this case study.
The psychological content from underwhelming psychedelic experiences is often overlooked and
the psychedelic treatment can be written off as unsuccessful. When participants on retreats do not
have a transformative experience, an overview of the process needs to be held, trusting that you
get what you need, no matter the insights. Fundamentally, it is the work that did happen, rather
than what the participant wanted to happen.
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Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
It is important to remember that the psychedelic experience holds no answers. It is not a magic
cure. Retreat centres are expensive and their marketing flawless, which may serve to further fuel
the notion of a silver bullet. Letting go of expectations is, for many, the work that needs to be
done. Therapeutically, we need to remain open to the possibility of the participant expecting to be
rescued, believing that if they had the perfect parents and were taken care of then they would
have been happier. This is then projected onto the psychedelic retreat setting and onto the
therapist. This can be further compounded by the media hype around the benefits of psychedelics.
This case study illustrates that the value of the therapeutic component requires further
investigation.
Retrospectively formatting this piece of work into a case study was not without difficulty. Client
consent was sought retrospectively which is not ideal, albeit their later collaboration was helpful.
The efficacy of this intervention was not objectively measured. Whilst this is customary in a private
practice setting, this piece of work falls short of the demands of full scientific integrity. More
extensive, objective psychometric measurements are needed to assess treatment efficacy. To
ascertain the cumulative impact of PsyA – EMDR therapy, a Randomised Controlled Trial (RCT) is
needed where PsyA-EMDR would be compared against other psychedelic preparation and
integration therapies such as EMBARK (Brennan & Bessler, 2022), ACE / ACT (Watts & Luoma,
2020), CBT, Jungian, and community-based interventions. Combinations of these therapies may
also enhance efficacy, and needs investigating. It is likely that such studies will happen once
licencing is granted. With promising early results from the Phase 3 clinical trials for MDMA and
psylocibin, this might be possible in the next three to five years. Further work is needed to develop
the PsyA-EMDR protocol before then.
The integrative nature of EMDR and the ongoing adaptions being made to work with a wide-range
of clinical populations means that it is well aligned to fit into a psychedelic-assisted therapy
protocol. EMDR allows for client focussed flexibility in the way it is implemented. The development
of AI and IG protocols can support transpersonal development which is often triggered by
psychedelic experiences. There is also scope to expand transpersonal aspects of the AIP model
further, if combined with the work of Carl Jung (Jung 2014) and Stanislav Grof (Grof 2003, Groff
2009). Psychedelic material often includes systemic and transpersonal content, so Jungian and
Grofian theories provide a supplementary framework.
13

Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
The measurable outcomes of systemic and transpersonal change are difficult to quantify. Given
the cultural impact of psychedelics in the 1960s, large scale population studies might provide
some insight into the impact that individual transformation has on the collective psyche (Jung
2014). Considered and measured application, along with robust and effective therapy, are
paramount to ensure that the mistakes from the 1960s are not repeated. Learning from the
mistakes of the entheogenic past, we know of the potential for depersonalisation, derealisation,
additional traumatisation or retraumatisation, reactivations (flashbacks), as well as overlooking
underwhelming experiences. EMDR can support the onward processing of such psychedelic
content. The psychedelic therapy community needs better tools when participants have such
difficult experiences. The eight phases of EMDR therapy have comprehensive, targeted tools for
grounding, resourcing and safety, and stabilisation, which can be easily lent to the discipline. The
AIP model guides the use of these interventions throughout the process.
The efficacy of private retreat settings can vary considerably. In addition to EMDR, this retreat
centre provided one group preparation session and seven post-dose integration sessions. The
client participated in this online community-based integration alongside the EMDR intervention.
These sessions were offered at +1 week, +2 weeks, +1 month, +2 months, +4 months, +6 months
and +9 months post dosing; the cumulative impact of which was not measured in this case
material. Community based integration groups (Thomas 2008, Kettner 2021) and horizontal care
structures provide important ongoing peer support and can be used in conjunction with vertical
models of care such as EMDR therapy.
Writing this case study has been a collaborative process. Whilst looking back through their journal
at the intentions that were set, the client acknowledged that their participation in this case study
has become part of their integration process. Our most sincere gratitude goes to them for their
generosity in sharing their personal story and the details of their unfolding process. Thanks too for
their collaboration in making this a true reflection our work together.
Summary
This case study illustrates how EMDR therapy, guided by the AIP model, can be used to explore
psychological content from non-ordinary states of consciousness using attachment informed
interventions. It shows how the eight phases can be used in a targeted way to develop a container
14

Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
for clients accessing psychedelic-assisted therapy. The stabilisation and resourcing interventions
during the preparation phases of EMDR are particularly suited to supporting psychedelic assisted
therapy clients. Over the past 30 years, EMDR has developed into a comprehensive treatment
for cPTSD, supporting those experiencing regressed ego states and those with an impaired ability
to self-regulate – states often accessed during work with psychedelics. This case demonstrates
how reprocessing can be used to prepare clients prior to a psychedelic treatment – activating the
nervous system and triggering somatic responses and biographical content. It also outlines how
psychedelic therapy compliments and amplifies the benefits of EMDR therapy. EMDR was used
to explore and integrate psychological material that emerged during the treatment, and the AI and
IG protocol adaptions facilitated this. It is hoped that this article will pave the way for more robust
research of PsyA-EMDR therapy and its potential as a hybrid psychotherapeutic intervention.
Further research
Legislative restrictions currently limit our capacity to investigate the impact of PsyA-EMDR.
According to Home Office definitions, Class A (Schedule I) restricted substances are deemed to
have no therapeutic value and therefore cannot be lawfully possessed or prescribed.This case
study contributes to a growing body of evidence that psilocybin holds significant therapeutic value,
undermining its position as a Schedule I restricted substance.
15

Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
References
Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008). Adverse childhood
experiences and chronic obstructive pulmonary disease in adults. American journal of preventive medicine,
34(5), 396-403.
Brennan, W., & Belser, A. B. (2022). Models of Psychedelic-Assisted Psychotherapy: A Contemporary
Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Frontiers in Psychology,
1879.
Bourzat, F (2019) Consciousness Medicine Indigenous Wisdom, Psychedelic Therapy, and the Path of
Transformation: A Practitioner's Guide. North Atlantic Books,U.S.
Browning, C. (1999). Floatback and float forward: Techniques for linking past, present and future. EMDRIA
Newsletter, 4(3), 12.
Carhart-Harris, R, Giribaldi, B. Watts, R. Baker-Jones, M. Murphy-Beiner, A. Murphy, R. Martell, J. Belmings, A.
Erritzoe, D. Nutt, D. (2021) Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med;384(15):1402-
1411.
Carhart-Harris, R. Goodwin, G. (2017) The Therapeutic Potential of Psychedelic Drugs: Past, Present and
Future. Neuropsychopharmacology; 42 (11) 2105-2113
Cavarra, M. Falzone, A. Ramaekers, J. Kupers, K. Mento, . (2022) Psychedelic -Assisted Psychotherapy – A
Systematic Review of Associated Psychological Interventions. Frontiers in Pychology,. 10 June 2022. Volume
13 – 2022 - https://www.frontiersin.org/articles/10.3389/fpsyg.2022.887255/full
Cozolino, L. (2014). The neuroscience of human relationships: Attachment and the developing social brain
(Norton Series on Interpersonal Neurobiology). WW Norton & Company.
Dalgarno, P., and Shewan, D. (2005). Reducing the risks of drug use: the case for set and setting.Addict. Res.
Theory13, 259–265. doi: 10.1080/16066350500053562
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. (1998) Relationship
of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse
Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58.
Freud, S. (1924) The Dissolution of the Oedipus Complex. The Standard Edition of the Complete Psychological
Works of Sigmund Freud 19:171-180
Flavell, J. H. (1979). Metacognition and cognitive monitoring: A new area of cognitive - developmental inquiry.
American Psychologist, 34(10), 906-911.
Gorman, I. Neilson, E. Molinar, A. Cassidy, K. Sabbagh, J (2021) Psychedelic Harm Reduction and Integration:
A Transtheoretical Model for Clinical Practice. Frontiers in Psychology, 15 March 2021 Sec. Psychopathology.
Volume 12 2021 - https://www.frontiersin.org/articles/10.3389/fpsyg.2021.645246/full
Grof, G. (2003) Implications of modern consciousness research for psychology: Holotropic experiences and
their healing and heuristic potential, The Humanistic Psychologist, 31:2-3, 50-85.
Grof, S. (2009). LSD: Doorway to the numinous: The groundbreaking psychedelic research into realms of the
human unconscious. Simon and Schuster.
Harner, M (1992) The Way of the Shaman.Paperback. Harper books; SanFrancisco
Hase, M., Balmaceda, U. M., Ostacoli, L., Liebermann, P., & Hofmann, A. (2017). The AIP model of EMDR therapy
and pathogenic memories. Frontiers in psychology, 8, 1578.
16

Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
Hubbard, A. Maclean, J. Macdonald, D. (1961)The Use of LSD-25 in the Treatment of Alcoholism and Other
Psychiatric Problems. In:Quarterly Journal of Studies on Alcohol 22, S. 34–45.
Jade, R. (2018).Integrating Underground Psychedelic Use: A Cautionary Note for Licensed Health Care
Providers. SSRN.
Jung, C. G. (2014). The Collected Works of. Routledge.
Kettner, H. Rosas, F. Timmermann, C. Kartner, L. Carhart-Harris, R. Rose,am, L. (2021) Psychedelic
Communitas: Intersubjective Experience During Psychedelic Group Sessions Predicts Enduring Changes in
Psychological Wellbeing and Social Connectedness. Frontiers in Pharmacology.
Klein, M. (1926)‘The psychological principles of early analysis‘. The introjected mother is distorted by the child’s
sadistic impulses. The writings of Melanie Klein.
Kohut, H. (1971). The analysis of the self. New York: International Universities Press.
Knipe, J. (2018). EMDR toolbox: Theory and treatment of complex PTSD and dissociation. Springer Publishing
Company.
Levine, P. (2015) Trauma and Memory: Brain and Body in a Search for the Living Past: A Practical Guide for
Understanding and Working with Traumatic Memory. North Atlantic Books
Metzner, R. (1998). Hallucinogenic drugs and plants in psychotherapy and shamanism. Journal of psychoactive
drugs, 30(4), 333-341.
Nour, M. M., Evans, L., Nutt, D., & Carhart-Harris, R. L. (2016). Ego-dissolution and psychedelics: validation of
the ego-dissolution inventory (EDI). Frontiers in human neuroscience, 10, 269.
Read, T. Papaspyrou, M. (2021) Psychedelics and Psychotherapy: The Healing Potential of Expanded States
Park Street Press, London
Rucker, J. Ko, K. Knught, G. Cleare A. (2022) Psychedelics, Mystical Experience, and Therapeutic Efficacy: A
Systematic Review. Frontiers in Psychiatry.
Ruffell, S,G. Netzband, N. Tsang, W. Davies, Merlin. Butler, M. Rucker, J. Tofoli, L, F. Demster, E, L. Young, A.
Morgan, C,J. (2021). Ceremonial Ayahuasca in Amazonian Retreats. Mental Health and Epigenetic Outcomes
From a Six-Month Naturalistic Study. Front. Psychiatry, 09 June 2021 - Sec. Psychopathology
Parnell, L (2013). Attachment Focused EMDR. Healing relational trauma. W. W. Norton & Company
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment,
communication, and self-regulation (Norton Series on Interpersonal Neurobiology). WW Norton & Company.
Shapiro, E., & Laub, B. (2008). Early EMDR intervention (EEI): A summary, a theoretical model, and the recent
traumatic episode protocol (R-TEP). Journal of EMDR Practice and Research, 2(2), 79.
Shapiro, F. (2001). Eye movement desensitization and repro- cessing: Basic principles, protocols and
procedures (2nd ed.). New York: Guilford Press.
Shapiro, F. (2001). “Trauma and adaptive information-processing: EMDR’s dynamic and behavioral interface,”
in Short-Term Therapy for Long-Term Change, eds M. Alpert, D. Malan, L. McCullough, R. J. Neborsky, F. Shapiro,
and M. Solomon (New York, NY: Norton), 112–129.
Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR
Practice and Research, 1, 68–87.
17

Rose, J. C. & Raine-Smith, H. (2023). EMDR as a preparation and integration tool in psychedelic-assisted therapy: a collaborative case study.
EMDR Therapy Quarterly, Vol 5 Issue 1, EMDR Association UK.
Found at: https://etq.emdrassociation.org.uk/case-study/emdr-as-a-preparation-and-integration-tool-in-psychedelic-assisted-therapy/
Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy. Basic Principles,
Protocols, and Procedures. (2nd Edition), London, UK: Guildford Press.
Schore, A. N. (2003). Affect dysregulation and the disorders of the self. New York: Norton.
Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in
development and treatment. Clinical social work journal, 36(1), 9-20.
Schore, A. N. (2021). The interpersonal neurobiology of intersubjectivity. Frontiers in Psychology, 12, 648616.
Siegel, D (1999). The Developing Mind. Guilford Press; 3rd edition (24 June 2020).
Siegel, D. J. (2001). Toward an interpersonal neurobiology of the developing mind: Attachment relationships,
“mindsight,” and neural integration. Infant Mental Health Journal: official publication of the world association for
infant mental health, 22(1 2), 67-94.‐
Thomas, P. Meads, G. Moustafa, A. Nazareth, I. Stange, K. Donnelly Hess, G. (2008) Combined horizontal and
vertical integration of care: a goal of practice-based commissioning Qual Prim Care 2008;16(6):425-32.
Van der Kolk, B. A. (1989). The compulsion to repeat trauma: Revictimization, attachment and “masochism.”
The Psychiatric Clinics of North America, 12, 389–411.
Watkins, J. G. (1971). The affect bridge: A hypnoanalytic technique. The International Journal of Clinical and
Experimental Hypnosis, 19(1), 21-27.
Watts, R., & Luoma, J. B. (2020). The use of the psychological flexibility model to support psychedelic assisted
therapy. Journal of Contextual Behavioral Science, 15, 92-102.
Watts, R. (2021). Psilocybin for depression: The ACE model manual.
Online
https://open-foundation.org/ - accessed 23.01.2023 at 16.13pm
Misuse of Drugs Act (1971) - https://www.legislation.gov.uk/ukpga/1971/38/contents - Accessed 14.01.2023 at 8.40am
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