Ayahuasca is a psychotropic plant-based tea from the Amazon. Its ceremonial use for therapeutic and spiritual purposes has become increasingly common and stands to escalate based on current policy initiatives in some countries. As ceremonial ayahuasca use spreads there is a need to understand, from various perspectives, how best to improve outcomes and minimize potential harms. Clinicians and therapists encourage the use of preparation and integration practices that accompany ceremonial ayahuasca use; however, there is no research investigating the views of those conducting the ceremonies. This qualitative study explored the perspectives of 15 ayahuasca ceremony leaders regarding preparation and integration practices they consider helpful for ensuring safe and productive experiences for ceremony participants. Qualitative content analysis produced three main categories, each with relevant subcategories. The first category included factors that facilitate preparation, including participant honesty and respect; readiness and willingness; and internal and external resources. The second category encompassed several complementary modalities believed to facilitate both preparation and integration, such as psychotherapy, spiritual and contemplative practices, and other modes of creative expression. The third category included factors considered facilitative of integration, including sharing of experiences, and working with insights and lessons. Ineffective integration practices constituted a fourth subcategory. Consistent with reports from other stakeholders, the findings highlight a wide range of preparation and integration practices that may be useful for ayahuasca ceremony participants to consider when drinking ayahuasca.