This article recaps the Psychedelic Support webinar “From Destabilization to Scientific Insights: Psychedelic Iatrogenic Structural Dissociation (PISD)”, presented by Steve Elfrink, founder of OmTerra, psycholytic somatic integration therapist, and co-author of the Psychedelic Iatrogenic Structural Dissociation hypothesis recently published in Frontiers in Psychology.
In this deeply personal and clinically grounded session, Elfrink explores a critical—and often overlooked—dimension of psychedelic work: what happens when expanded states dissolve protective psychological structures faster than a system can integrate them. Drawing from his own destabilizing ayahuasca experience, decades of somatic clinical practice, and contemporary trauma theory, he introduces PISD as a framework for understanding how psychedelics can unintentionally cause harm in trauma-exposed individuals when pacing, containment, and integration are insufficient.
🎥 Watch the Webinar Replay: From Destabilization to Scientific Insights: Psychedelic Iatrogenic Structural Dissociation (PISD) with Steve Elfrink
A Story That Became a Hypothesis
Rather than beginning in a lab or clinic, the PISD hypothesis emerged from lived experience.
Elfrink recounts an ayahuasca ceremony undertaken with sincere spiritual intention—one that instead precipitated a prolonged period of depersonalization, emotional flooding, and the resurfacing of early developmental trauma, including aspects related to his birth. What initially appeared to be a “bad trip” or spiritual emergency did not resolve with time. Instead, it unfolded into a year-long destabilization that resisted conventional explanations and left him struggling to re-establish internal coherence.
Rather than dismissing the experience or attempting to override it, Elfrink turned toward trauma science.
“It became clear to me that something structural had happened,” he explains. “Not a pathology—but a loss of organization.”
That inquiry led him to the theory of structural dissociation, a trauma framework describing how the psyche adapts to overwhelming experiences by dividing functioning between parts oriented toward daily life and parts carrying unprocessed emotional material.
Structural Dissociation in Psychedelic States
Structural dissociation distinguishes between two primary modes of functioning:
- Apparently Normal Personality (ANP): the part oriented toward daily functioning, avoidance of traumatic material, and social engagement
- Emotional Personality (EP): the part that holds traumatic memory, affect, and survival-based defensive responses
Under ordinary conditions, these parts coexist with protective separation. Psychedelics, however, can rapidly dissolve the boundaries between them.
For individuals with early or complex trauma histories, this dissolution may occur before sufficient internal or relational resources are available to support integration.
“When dissociative defenses fall too quickly,” Elfrink notes, “the system can become overwhelmed rather than healed.”
This phenomenon—harm unintentionally caused by an intervention meant to help—is what Elfrink refers to as psychedelic iatrogenesis.
What Makes Psychedelic Iatrogenic Structural Dissociation Distinct
PISD is not a rejection of psychedelic therapy, nor is it an argument against non-ordinary states themselves.
Instead, it names a specific risk pattern that can emerge when:
- Trauma defenses dissolve rapidly
- Emotional material floods consciousness without titration
- Somatic and relational grounding are insufficient
- Integration support is minimal or absent
In these conditions, individuals may experience prolonged destabilization, identity fragmentation, emotional dysregulation, and difficulty returning to baseline functioning.
Crucially, Elfrink emphasizes that these outcomes are not evidence of personal failure or fragility.
“They’re signs that the system did exactly what it was designed to do—until the intervention pushed it faster than it could reorganize.”
“Psychedelics should not be framed as inherently corrective. They are amplifiers—of both resilience and vulnerability.”
— Steve Elfrink
Expanded States, the Nervous System, and the Window of Tolerance
Elfrink situates PISD within a broader neurophysiological context.
Psychedelics disrupt the Default Mode Network, soften ego boundaries, and amplify emotional and somatic awareness. For some, this creates insight and relief. For others—particularly those whose nervous systems developed under threat—it exposes material that the system originally dissociated precisely because it was once unbearable.
Without adequate pacing, the nervous system may move outside its window of tolerance, resulting in overwhelm rather than integration.
Elfrink repeatedly returns to a central principle:
“Healing isn’t about how much material you access—it’s about how much you can stay in relationship with.”
This reframing shifts the emphasis from peak experience to capacity, containment, and continuity.
Related Perspectives on Psychedelic Risk and Integration
Explore approaches to understanding and integrating non-ordinary states with greater care—especially when pacing, containment, and nervous system capacity matter:
- We Need to Talk About When People Feel Worse After Drinking Ayahuasca — A grounded exploration of post-ceremony distress that challenges the “medicine always heals” narrative and centers care over blame.
- Healing Crisis After Ceremony: What It Means and How to Move Through Psychedelic Integration — Understanding the difference between growth-related discomfort and true destabilization, with guidance on navigating difficult aftermaths.
- The Most Common Extended Difficulties Following Psychedelic Use — An overview of documented long-term challenges that can follow psychedelic experiences, helping normalize and contextualize prolonged difficulties.
- Somatic Therapy and Psychedelic Integration — Why body-based approaches matter in integration, especially when nervous system pacing and titration are essential.
- The Risks of Self-Medicating Alone with Psychedelics — A harm-reduction perspective on why screening, preparation, and relational support are critical for safety.
The Role of PSIP and Somatic Titration
Elfrink draws on his work as a co-founder of Psychedelic Somatic Interactional Psychotherapy (PSIP), a protocol emphasizing bottom-up, body-led processing rather than cathartic emotional release.
Somatic approaches recognize that trauma is not held solely in narrative memory, but in physiological patterns of activation and defense. By tracking sensations, impulses, micro-movements, and autonomic shifts, practitioners can support integration without overwhelming the system.
Rather than attempting to “break through” defenses, PSIP and related approaches invite collaboration with protective parts.
“Those defenses formed for a reason,” Elfrink reminds us. “Respecting them is part of the healing.”
Implications for Preparation, Screening, and Integration
A central takeaway from the webinar is the urgent need for trauma-informed psychedelic care.
Elfrink highlights several key considerations for clinicians, facilitators, and participants alike:
- Screening matters: developmental trauma, dissociation, and attachment history must be assessed rather than minimized
- Preparation is not optional: nervous system literacy and somatic resources should precede medicine work
- Pacing is protective: more intensity does not equal more healing
- Integration restores safety: without it, experiences can remain fragmented
Psychedelics, Elfrink argues, should not be framed as inherently corrective. They are amplifiers of both resilience and vulnerability.
Follow your Curiosity
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One of the most resonant themes of the webinar is Elfrink’s critique of psychedelic bypassing—the tendency to equate intensity, insight, or spiritual imagery with healing itself.
“Healing isn’t what happens in the experience,” he says. “It’s what happens afterward, in how we live with what emerged.”
This perspective aligns psychedelic work with broader trauma-informed and parts-based models, including Internal Family Systems and structural dissociation theory. Healing becomes less about transcendence and more about relationship, repair, and embodied presence.
A Call for Ethical Maturity in the Field
As psychedelic therapy enters increasingly mainstream clinical and legal contexts, Elfrink’s message is both cautionary and hopeful.
The field, he suggests, is at a developmental crossroads. Without humility, education, and ethical rigor, psychedelic work risks replicating the very harms it seeks to address. With discernment, it has the potential to mature into a genuinely integrative healing modality.
“These medicines are powerful,” he concludes. “Power requires responsibility.”
Closing Reflection
Psychedelic Iatrogenic Structural Dissociation challenges the field to slow down, listen more carefully, and honor the intelligence of the nervous system.
Healing, Elfrink reminds us, is not about breaking open—it’s about staying connected.
And sometimes, the most ethical intervention is not going deeper, but learning how to hold what the medicine has already revealed.
About Steve Elfrink
Steve Elfrink is the founder of OmTerra, a psycholytic somatic integration therapist, and co-author of the seminal manuscript on Psychedelic Iatrogenic Structural Dissociation (PISD) with Leigh Bergin.
With over four decades of experience in psychedelic exploration and trauma-informed clinical practice, Elfrink is a leading advocate for somatically grounded, ethically paced approaches to psychedelic therapy. He co-founded the Psychedelic Somatic Institute, where his team developed the PSIP protocol, and currently works as a licensed psilocybin facilitator in Oregon.
His work is profoundly shaped by his own transformative—and destabilizing—psychedelic experiences, fueling an ongoing commitment to safety, integration, and long-term healing.
Resources from the Webinar
🌐 Learn More & Connect with Steve
- Find Steve Elfrink on LinkedIn
- Learn more about OmTerra at omterra.org
- Read the manuscript on Psychedelic Iatrogenic Structural Dissociation (PISD)
📜 Courses & Continuing Education
- Free Harm Reduction Course: Riding the Wave: Principles of Psychedelic Harm Reduction
- Psychedelic Counseling: The Foundations of “Trip Sitting”
- Conscious Journey (Course): Navigating Psychedelic Exploration and Self-Discovery + Workbook (Print)
- Integration Intensive Retreat: 3-day experiential retreat in beautiful Big Sur, California
- Upcoming Online Speaker Events: Monthly Speaker & Professional Networking Series
- Accredited CE/CME Courses: Psychedelic Therapy Education & Training Programs
- Earn CE for Webinar Events: Psychedelic Therapy Continuing Education Series (CE) – $120 for the whole series!
