Healing Journeys: Navigating Trauma in Psychedelic Therapy

Overview: Steve Elfrink is a pioneer in the field of psychedelic medicine and integrative healing, with over 40 years of experience. As the founder of OmTerra, he has dedicated his life to developing safe, trauma-informed approaches to psychedelic therapy. In his work, Steve combines personal insights with rigorous clinical research to help individuals navigate challenging psychedelic experiences and integrate profound healing. In this article, he shares his journey, professional expertise, and innovative methods for supporting recovery and transformation in those affected by trauma.

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Introduction

Psychedelic therapy offers powerful healing potential, but it can also sometimes stir up deep, unresolved emotional trauma. This is where the concept of Psychedelic Iatrogenic Structural Dissociation, or PISD, comes in. In simple terms, PISD refers to situations in which a psychedelic experience inadvertently reactivates hidden, dissociated parts of the self—often linked to early trauma—in a way that can feel destabilizing.

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Understanding Dissociation and Trauma

• Dissociation: Think of dissociation as the mind’s way of protecting itself from overwhelming stress or trauma. When someone experiences a traumatic event, their mind may “split” off certain emotions or memories as a way to cope. This protective process helps the person function day-to-day but can leave some painful memories unintegrated.
• Structural Dissociation: This concept divides our personality into two parts:
  • The Apparently Normal Personality (ANP) helps us manage everyday life.
  • The Emotional Personality (EP) holds repressed traumatic memories and intense feelings.
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In PISD, a psychedelic experience can sometimes cause a sudden reactivation of the EP, overwhelming the ANP and causing feelings of confusion, anxiety, or being “split apart.”

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How Psychedelics Can Impact Dissociation

Psychedelics are known for their ability to shift our perceptions and open us up to deep emotional experiences. For many, this can lead to profound healing. However, for some individuals—especially those with unresolved early trauma—these substances may:

• Trigger Latent Trauma: Psychedelics might bring long-dormant traumatic memories to the surface. While this can be an opportunity for healing, it can also be destabilizing if the person is not adequately supported.
• Overwhelm the System: When the brain is suddenly flooded with repressed emotions, it can lead to intense feelings of dissociation. This might manifest as a loss of connection with one’s body, feelings of unreality, or even a sense that one is being torn apart internally
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Why Awareness and Support Matter

Understanding PISD is crucial for both therapists and patients. It highlights the need for:

• Trauma-Informed Screening: Before engaging in psychedelic therapy, it’s important to identify individuals who may be at risk due to unresolved trauma. This helps in planning a safe therapeutic approach.
• Preparation and Integration: Therapists need to prepare clients for the possibility of challenging experiences and provide structured support afterward. Techniques like somatic integration (focusing on body awareness) and gradual, titrated therapy sessions can help safely process and integrate reactivated trauma.
• Safety and Care: For anyone undergoing psychedelic therapy, having a trusted support system—both during and after the experience—is essential. This may include having a therapist, guide, or community to help navigate any difficult emotions that arise.
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Moving Forward

PISD is a concept still being explored by researchers and clinicians, with groundbreaking work published in respected journals like Frontiers in Psychology. By increasing awareness of how dissociation and trauma interact during psychedelic experiences, we can work towards safer and more effective therapeutic practices.

Whether you are a therapist seeking to support your clients or a patient considering psychedelic therapy, understanding PISD can empower you to approach these transformative experiences with care and informed guidance.

Remember, the goal of psychedelic therapy is healing. With proper screening, preparation, and integration, even challenging experiences can be transformed into opportunities for deep personal growth.

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Reference
Elfrink, S., & Bergin, L. (2025). Psychedelic iatrogenic structural dissociation: an exploratory hypothesis on dissociative risks in psychedelic use. Frontiers in Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1528253

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