Feeling Clearly: How Ketamine-Assisted Psychotherapy Helped a Father Overcome Severe Social Anxiety and Childhood PTSD

By Greg Ferenstein

An Unrelenting Specter of Judgment

Tom* couldn’t shake his constant fear of being perceived as awkward and unworthy of friendship.

“I always felt like the outcast,” he recalls. The crippling self-doubt kept all of his relationships at a cold distance, even his wife.

In everyday social situations, even light-hearted water-cooler conversations at work, Tom was haunted by thoughts about why people right in front of him—freely engaging with him in conversation—silently judged him as unpleasant.

Tom had done the work to figure out the source of his dread. After years of therapy, he knew it came from an abusive childhood growing up in a religious culture that used shame and bullying to enforce conformity. As a result, he ran away as a teenager.

One notable symptom of trauma is “hyper-vigiliance”, or an over-sensitivity to threats in everyday situations.

“I was on high alert all the time," he remembers.

His relationships were shallow because he avoided social activities. Even surrounded by those who loved him, he was still alone and fearful.

Addictive Attempts

Determined to be more social, Tom looked for solutions. While they did improve his anxiety, they also came with troubling trade-offs.

One was a popular and controversial legal drug, Phenibut, a synthetic anti-anxiety supplement originally synthesized in the USSR for cosmonauts.

Phenibut acts on the central nervous system by inhibiting the neurotransmitter, GABA. Essentially, it can dull reactions to perceived dangers. Because Tom was not in any true danger, it was a workable solution that gave him the confidence to be more social.

Unfortunately, Phenibut is highly addictive and there are reports of painful withdrawal. Tom remembers one occasion when he forgot to take one of his various anti-anxiety supplements on the way to a movie with his wife and they had to immediately turn back, making them late for the show.

Being tethered to addictive, unapproved medical treatments was clearly not helping him or his relationships.

Ketamine and a Feeling of Unconditional Love

Tom came across a Facebook ad for a new therapy at Novamind’s Cedar Psychiatry in Utah using ketamine, a surgical-grade general anesthesia that was being used to treat mental illness, including social anxiety disorder.

“I didn't quite know what to expect," he recalls of his general aversion to psychedelic-assisted therapy. “This was kind of my last hope."

Desperate for better options, Tom scheduled an appointment and brought his wife with him for support.

Tom remembers the luxury gravity chair that he sat in while the IV ketamine infusion was placed in his arm. He began drifting off into a dream-like state and felt as if he was tipping over backward in the chair, but the fear subsided.

“It’s ok, just let go," he recalls telling himself. For Tom, the psychedelic aspect of ketamine was not about wild hallucinations, but a feeling of ease. “I fell into this black space."

Tom’s thoughts drifted to his wife and he felt unconditional love. Prior to the appointment, he had worried about bringing her, since he felt silently judged for turning to psychedelics for treatment, even though she had never expressed skepticism about the approach.

But that feeling was replaced with one of acceptance. With ketamine, “You get to see yourself in third person," Tom explains. He experienced, at a visceral level, how others saw him and he knew they didn't judge him as he feared they did.

Instead, he could simply be beside his wife. “She held my hand; I felt so loved."

Feeling Less Judged

"Our marriage has skyrocketed," Tom says proudly. He also has more energy to enjoy swimming and going to the gym with his wife.

"I feel like going outside because I don't feel like there are eyes everywhere judging me."

Tom still has more ketamine treatments to go but feels he’s on a better path.

He seems to take challenging social experiences less personally. If someone disagrees with him, there is “zero emotion attached" to the argument.

Without constant rumination about what he’s doing wrong, he’s able to put challenges into perspective.

What Seemed to Work

Tom says that two things, in particular, stand out in his mind about what helped, aside from his wife being at his first treatment.

The first was listening to unfamiliar music. Music can have a calming, meditative effect during psychedelic episodes, allowing people to more deeply drop into a dream-like state. However, listening to familiar music can dredge up unpleasant memories that could distract from seeing oneself in a new light.

The second was Tom’s experience with mindfulness therapies prior to ketamine, including meditation and another called Eye Movement Desensitization and Reprocessing (EMDR).

The basis of both strategies is to embrace difficult thoughts and memories as they come up. Tom doesn’t know whether having these psychological tools in his toolbelt made the difference between successful and unsuccessful ketamine treatment, but he did have the honed skills to address challenging thoughts during the treatment.

So, it is worth noting that people who have come from therapy might be able to use the tools they’ve learned from previous counselors with ketamine. This is why Cedar Psychiatry is careful to prepare patients with the mindfulness tools they’ll need to navigate the psychedelic experience and integrate insights afterward.

It certainly seemed to work for Tom. "It changed my entire life," he concludes.

*Tom is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Fully Present: How Ketamine-Assisted Therapy Helped One Woman Out of Depression

By Greg Ferenstein

Michelle* lived with constant anxiety that she would explode during an argument and enter into a months-long depressive episode. She’d tried so many strategies to manage her mental health, from group discussions to cognitive behavioral therapy, but nothing seemed to work well.

“Most of the therapy I’ve done just kind of muted my symptoms mostly, but I am still walking around with heavy, heavy depression and really terrible anxiety.”

Depressive episodes would socially paralyze her.

“I wouldn’t feel like I had any energy to do anything. I’d isolate myself,” she says. “I'm not social. I don't function besides what I absolutely have to function for.”

She could work but that was about it.

Unfortunately, the most effective solutions for her had intolerable side effects. The generic version of Zoloft, Sertraline, managed her major mood swings but came with “horrible” sweats that left her “drenched” in the middle of the night. Perhaps worse, it severed her emotions.

“It made me not care at all,” Michelle recalls. “I just kind of didn't feel anything.”

After her doctors recommended trying a higher dose, she went looking for something else. Her friends said good things about ketamine, a dissociative psychedelic that is known to help people confront painful topics and manage a range of mental health conditions, including depression.

Michelle was nervous. She had some not-so-positive experiences with psychedelics when she was younger. Even though it was years ago, she didn’t like the idea of losing control of her mind.

The therapists at Numinus made her feel more at ease with their Emotion-Focused Ketamine-Assisted Psychotherapy, which pairs intensive emotional management and trained mental health professionals with multiple rounds of in-person ketamine sessions.

The Ketamine Experience

The psychedelic portions of ketamine treatment typically last an hour and many people report hazy dreams representing unprocessed challenges.

After years of therapy, Michelle believed she knew the source of what she might encounter: being abandoned by her mother as an adolescent and subsequent years in-and-out of near homelessness.

Instead, her most healing psychedelic experiences were simple and pleasant experiences.

She remembers telling her husband, “Maybe this is what it feels like to feel normal.”

The simple absence of anxiety was profound. After one session, she burst into tears.

“I just started crying and crying and crying,” she recalls. “I really felt like it helped me release those emotions, and relieve some of that pain and all of the struggle that I had when I was a child with my family.”

During another psychedelic experience, Michelle set an intention and drifted into a meditative state, daydreaming of swimming. Usually, when water was involved in Michelle’s dreams, it was a nightmare drowning sensation. This watery dream, though, was superbly healing.

“I have been a hyper-vigilant person, always looking for the next thing to crumble in my life,” she says. “But with ketamine, just to even have that feeling that I'm okay—and that I'm happy—was huge for me.”

Introspection, fewer explosions, less depression

In the three months since Michelle had her first ketamine treatment with Numinus, she has learned to better manage her emotional triggers.

One example stands out. Because of their shared traumatizing past, her family has had a tendency to set her off. But the last time they had a fight, Michelle recalls being able to remove herself from the argument, sensing that she was about to explode, and embrace her feelings without becoming overwhelmed by them.

“It's getting easier for me to recognize, even in conversation.”

She feels more in touch with her emotions, and if things start feeling really bad, she can discuss her emotions openly in a way that defuses the situation.

Her relationship with her husband has improved and she is no longer burdened with extended bouts of depression. She’s made incredible progress, but Michelle still struggles with explosive episodes and depression. So, she continues to go in for occasional ketamine treatments.

But she no longer needs antidepressants.

“It has really, really, honestly been the only thing that has helped me feel normal without taking a pill every single day.”

*Michelle is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Healing My Worth: How Ketamine-Assisted Therapy Helped One Woman Out of Depression

By Greg Ferenstein

 

Sarah* couldn’t understand why she felt such debilitating depression. On paper, she seemed to be doing everything right. She practiced yoga, ate well, and was raising two well-adjusted children. Her supportive family and healthy lifestyle helped her overcome a difficult cancer treatment, yet she was consumed by dark ruminating.

“I find myself constantly apologizing to everyone,” she recalls, of the crippling self-doubt that led to serious suicidal ideation.

Intuitively, she knew people loved her, but couldn’t stop her reaction to apologize as never being good enough for her family. Sometimes, the mere gentle embrace of her husband would send her into a sobbing fit.

“My kids were scared when I got really suicidal,” she admits.

Traditional therapy and medications had been somewhat helpful. One of the anti-depressants that she tried, specifically, Zoloft, took the edge off of otherwise brutal, constant rumination.

“I was more stable—I was much more approachable.” With Zoloft and talk therapy, Sarah’s relationships were more manageable. She could work, raise her kids, and not break down crying around her husband.

But, eventually, the trade-offs from Zoloft, and anti-depressants generally became too much. First, Sarah’s cancer medications interacted poorly with Zoloft.

Second, it strained relations with her husband in unexpected places like the bedroom. “There’s kind of a sexual dampening effect.”

Her husband wanted to be desired physically, but as an emotional ‘zombie’, Sarah just couldn’t feel it.

“I wasn’t filling that need for him because I wasn’t feeling it within myself,” she recalls. “I wanted to feel well, but I also wanted to feel everything.”

Eventually, Sarah’s therapist proposed a relatively new psychedelic pharmaceutical treatment, ketamine, a widely used surgical general anesthesia known to have potent antidepressant effects. In the dreamlike state of this powerful analgesic, patients can often process memories that are too painful to deal with normally.

Sarah’s initial ketamine treatments were positive, but they did not seem to alleviate her issue, nor did they help her understand the source of the depression.

So, she decided to try a new ketamine provider, Novamind, a growing mental healthcare company specializing in psychedelic-assisted therapy. Having treated thousands of patients using various ketamine therapies, Novamind was uniquely equipped to address Sarah’s challenging situation. In her case, Novamind providers used Emotion-Focused Ketamine-Assisted Psychotherapy or “EF-KAP”. EF-KAP is a special type of ketamine-assisted psychotherapy that focuses on helping patients learn to identify, cope with, and transform emotions related to their mental health condition. It is based on principles found in Emotion-Focused Therapy, an approach to psychotherapy that clinical research has shown is very effective.

A transformational visualization

Initially, Sarah remembers feeling “terrified” of psychedelics. Her fears ran the whole gamut of disaster scenarios, from suffering a hypothetical permanent psychosis to simply not ‘returning’ to her normal psychological state of being able to care for her family.

“I’m kind of a control freak,” she says.

But, she was desperate and willing to trust in the confidence of her mental health team.

Under Novamind’s care, Sarah recalls the trip that transformed her mental health. Sitting in a comfortable chair and dimly lit room, a ketamine IV was placed in her arm and she drifted off into a state that felt like the semi-conscious awareness of waking up from a long sleep.

In her dream, a building stood out in the middle of a big, cosmopolitan city. She peered in and could empathize with the hundreds of families seen through the windows. Soon, she witnessed the glow of different family members dissolving from what looked like divorce. But, it wasn’t a sad occasion, as each person floated into another room with a new, loving family unit.

To Sarah, this was a revelation: as the child of a difficult divorce, she realized how the scars of feeling unloved during her parents’ separation never fully healed. But, in her psychedelic vision, she understood separation as a natural part of life.

“My energy can now leave and go flow elsewhere.” Sarah did not have to take the scars of being unloved from her childhood into her role as a mother. “I equated trying to be perfect with getting love.”

She says that she could choose to accept the unconditional love of her husband and children, even if she is imperfect.

No more apologizing or suicidal thoughts

Sarah recalls feeling unusually pleasant in the days after the experience. Her first assignment was to ditch her knee-jerk reaction to apologize—and it worked.

She was determined to be “more mindful every time I wanted to say ‘sorry’.” Instead, she knew, “I could just show up and be enough.”

Soon, relations at home improved. Before the therapy, Sarah had become physically estranged from her husband, who had stopped being affectionate for fear of triggering a depressive episode. But, now, he could embrace her with a loving hug. It was the little things like this that gave her more confidence and began the road to repairing intimacy in her marriage.

Initiating intimacy ran both ways: now that she felt a fuller and more intense range of emotions, Sarah is comfortable in her body. She is less judgmental about her weight and image. In the bedroom, she enjoys connecting and is less likely to cover under the sheets.

“Years of eating disorders and body dysmorphia, and body shame had prevented me, for a long time, from really being present in my body.”

Sarah still has shaky days, but is staying vigilant in her practice of mindfulness. She finally believes, at her core, “I’m worth being here”.

Exploring the nuances of what worked

Sarah was no stranger to psychedelics; she’d experimented liberally years ago with LSD and psilocybin, both of which are known to have antidepressant properties in therapeutic settings. And, she had come to Novamind recently for ketamine treatments.

So, what was different about this particular transformation experience?

Novamind’s Dr. Stephen Thayer, who oversaw her care, credits two things in particular to the healing process.

First, Sarah was instructed how to ‘recall’ her psychedelic experience in her everyday life as a method of integrating the insights she learned while on ketamine. During challenging times, Sarah takes a moment to breathe and mindfully reflect on these insights, allowing her to emerge fortified and less self-critical. Dr. Thayer describes this process as following breadcrumbs back to insights first encountered during the ketamine experience.

Second, both Dr. Thayer and Sarah credit the unobtrusive talk therapy during the trip with a trusted counselor.

In many ketamine infusion clinics, clients go through the experience without supportive psychotherapy.

Sarah’s case is a fascinating example of why this kind of support may be crucial to the healing process. Ordinarily, she admits, anxiety would get the best of her and she would feel the need to do anything else but sit with her difficult emotions. That guidance involved open-ended questions, invitations to be curious, and reminders that she was safe. Being invited to describe the visualizations mid-trip helped uncover the meaning of the dream-like state and gave her the courage to dive deeper into the experience.

For Sarah, it made all the difference.

*’Sarah’ is a pseudonym. Some quotes edited for clarity.

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Rooted in Love: How Ketamine-Assisted Therapy Helped a Frontline Worker Overcome Anxiety and Burnout

By Greg Ferenstein

Christine* had finally managed to get her acute anxiety and depression under control and wean off a decade-long reliance on antidepressants. But when COVID-19 hit in 2020, she became increasingly overwhelmed. Though she had a huge stack of responsibilities—as a mother of three, a wife, and a frontline clinical therapist—Christine was debilitated by constant ruminating fears that she would fail her responsibilities.

“How do you help people when you also feel like you’re drowning?" she remembers thinking.

In her personal life, Christine struggled with a lack of self-worth, which impacted her husband and child.

“I just wouldn't show up as my best self, so I'd be more irritable with them—more easily frustrated with them—even though I was really frustrated with myself.”

The fear and tensions caused further distance from those she loved; she experienced serious physical intimacy issues with her husband, and in social situations, she found herself turning inward rather than being the energetic friend she wanted to be.

Christine began to isolate more and more, describing her collapse inward as a practice of self-care.

“I remember just taking multiple walks a day, just trying to get out of the house.”

Ironically, these attempts took her away from her responsibilities and worsened her mental health challenges.

Feeling defeated, Christine decided to go back on her antidepressant medication to manage her depression. While the medication gave her more energy to be productive, it exacerbated other problems.

“It was really good at helping my depression, but it had the side effect of increasing my anxiety if my dose was too high. And so, there was a lot of playing around with dosages, and I never ever really found something that felt really good.”

The Ketamine Experience

Christine was desperate for a better solution. A few of her therapy clients had told her about their experience with psychedelic-assisted psychotherapy, in both the underground and with ketamine in clinics.

“I had literally never taken any sort of substance to change my state at all. I really had no idea what to expect.”

Christine was still nervous to try psychedelics by herself, but a colleague had told her about a positive experience at Novamind, a psychiatry clinic that specializes in ketamine-assisted psychotherapy. As a frontline worker affected by the stress and trauma of the COVID-19 pandemic, she qualified for their ongoing clinical pilot program for group therapy, where she and two others would undergo three sessions of oral and intramuscular ketamine, guided by a licensed psychotherapy team.

Ketamine, a dissociative anesthetic, can bring patients into a daydream-like state where their mental health challenges morph into insightful visualizations.

Going into her first psychedelic experience, Christine had set the intention of processing her issues of “enough-ness” and expected to find an answer detailing why she was an amazing caretaker. Yet, she got quite a different insight.

Christine began to see images of a large tree, which felt as though it represented a long lineage of caretakers, supporting both her and those she loved.

“What the ketamine kind of showed me was how I was actually connected. And I was a part of something much larger. And for me, that was my ancestry. So, I had these visualizations of seeing myself from above and having this family tree.”

Christine, for the first time, began to realize that she was not the only thing protecting her loved ones or her patients.

“I think it really comes down to this sense that I'm not alone and that these things are not just on my shoulders.”

Christine had placed unrealistic burdens on herself as a mom and as a therapist. She realized she could be imperfect and ask for help and this was enough.

Christine also notes that the group aspects of the therapy were essential to integrating these insights into her life.

“They also had some really powerful experiences, and they could understand maybe the weirdness.”

Psychedelic insights can be unusual. For Christine, it was vital to be surrounded by people like herself who understood the experience and why it was meaningful.

A More Confident Christine

Christine is happy to report that she is fully off her antidepressants and feeling much better.

She finds herself lashing out less in irritation at her family. As a therapist, she finds herself more present and grounded with her clients.

“I feel like my nervous system is a tool that I use with my clients and the more regulated I can be and the more I can feel myself in a grounded place, I can show up better for my clients. So, I do think that I'm giving better quality service.”

Perhaps just as important, she feels more vivacious and connected in her social life.

“In those social situations, I find myself sharing more and being more engaged, worrying less about saying the right thing or something that they wouldn't necessarily want to hear. And coming home or coming away from most situations and not being nearly as drained as I had been over the past few years.”

Christine credits new mindfulness skills with her continued mental stability. During one of her more intense psychedelic journeys, she experienced a so-called “ego death”, which she describes as an out-of-body feeling where she could independently observe different parts of her psyche.

During this daydream, Christine could hear the chatter of her negative, depressive, and judgmental self. "When are you going to post about this on Instagram?" she remembers hearing. But as a disembodied observer, she began to understand that these judgmental ruminations were a part of her psyche trying to care for her.

She could listen to the judgmental and worrisome voices without letting fear overcome her.

Now, when she begins to involuntarily ruminate, she’s better able to practice a form of mindfulness and experience a sense of objective awareness of the voices.

“Even significant family issues can be resolved and those feeling that come from that can be resolved in just a matter of hours, versus something that persists. And I ruminate on and it sticks with me for a very long time, and just kind of keeps me in that bogged down stuck place.”

Overall, Christine is feeling less anxious and depressed. She hasn’t resolved all the issues (she still sees a counselor with her husband) but is grateful for the progress made.

“I loved the entire structure of the experience.”

*Christine is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

How to Get the Most From Your Telepsych Visit

By Mallory Danielson M.P.H., PA-C

Communication over video has become the preferred method of many patients and providers given the situation with COIVD-19. Cedar Psychiatry does have video visits, or Telepsych as we like to call it, available to any patient doing a follow-up or intake visit.

HOW TO UTILIZE TELEPSYCH

  1. Make an appointment, let the staff know you’d like to have this visit be a Telepsych visit.

  2. Before your appointment please go to Cedar Psychiatry’s website (https://www.cedarpsychiatry.com/telepsychiatry) to find your provider’s individualized digital waiting room.

  3. This will take you to doxy.me, a HIPAA compliant, secure website that hosts our video chats

  4. You don’t need to make a log-in, just follow the prompts to let your provider know you’re there

  5. Once they’re ready, your provider will initiate the video chat.

HOW TO MAKE TELEPSYCH THE MOST EFFECTIVE

Most of us have used Google Hangouts or Facetime before but have never used it in a professional setting. To have your Telepsych visits be as effective, personable, and useful as your in-person visits we have a few tips:

1. SHOW UP EARLY

Head to your provider’s digital waiting room 5-10 minutes early to take advantage of doxy.me’s “Pre-call Test”. This will ensure your internet, camera, and microphone are working.

2. FRAME YOUR FACE

It’s hard to do a Telepsych visit when the other person is just a dark shadow or the camera is looking directly up their nose! Try to set up or hold your camera so it is still, so you can see your whole face, and try to have a light shining on your face so you can be seen.

3. CALL FROM A PRIVATE PLACE

Talking about your mental health can be difficult and personal. Make it a little easier by calling from a private place without interruptions. Try calling from a room with the door closed or even your parked car.

4. CALL FROM A QUIET PLACE

Having conversations in the background, the radio going, or other noises can detract from your conversation with your provider. Remember that this appointment is important to your mental health, take it seriously, and keep background noises to a minimum. Use headphones to reduce feedback.

5. BE ENGAGED

Video makes it easy to get distracted and forget proper conversation etiquette. Do your best to keep eye contact by looking into the lens of your camera. Stay still, don’t walk around, or do something else during your appointment. Remember, this is still your visit, respect your time and the time of your provider by making the most of this video call.

Julie Andrews: "Therapy Saved My Life"

Depression, more common than either cancer or heart disease, is the leading cause of ill health & disability worldwide, yet 50% of people with depression don't get treatment.

1 in 4 people will face mental illness at least once in their lifetime, but why do governments only invest 3% of their health budgets in mental health?

Going to a therapist or psychiatrist should be as normal as going to your family doc when you have the flu. Even though it's getting better, the stigma is still out there. So, you can imagine how pleased we were to hear about this conversation on The Late Show with Stephen Colbert:

"Colbert asked Andrews about the decision to discuss her history with therapy in Home Work. Andrews' first stint in therapy took place after her separation from her first husband, when "my head was so full of clutter and garbage." Mike Nichols, who she admired for being clear-headed, was going to therapy and so she gave it a try. As for why she shared this with readers, Andrews replied, "The truth is, why not, if it helps anybody else have the same idea? These days, there's no harm in sharing it, I think everybody knows the good work it can do."

We need to talk more about our mental health. We get this message from society that asking for help is weak, but maybe society needs some therapy. Therapy is cool, psychiatry is rad, and working on your mental health is a sign of strength, not weakness. It's showing up for ourselves so we can be there for the other people in our lives too.

 

 

Episode 40: Dr. Robert Grant on Internal Family Systems Therapy

“What’s healing is the self to part relationship. And that relationship gets built based on the part being able to tell its story without repercussions.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Robert Grant. Dr. Grant is an Internal Family Systems (IFS) therapist, a ketamine-assisted psychotherapist, a pulmonary physician, a professor of medicine at UCSF, a former researcher in HIV prevention and treatment, and a cofounder of the Healing Realms Center. The Healing Realms Center is a clinic specializing in ketamine-assisted psychotherapy.

Dr. Grant is especially well known for his work as an IFS therapist specializing in ketamine treatments. IFS was developed by Dr. Richard C. Schwartz. It is a therapy based on the notion that the human mind is made up of inner parts. And healing involves the cultivation of harmony among these parts. It is commonly used in the treatment of post-traumatic stress.

 

In this interview Dr. Joe and Dr. Grant explored:

 

Here is more information on subjects mentioned in this episode:

 

More quotes from Dr. Grant from the interview:

 

“It was the human connection that was curative. And the mescaline was helpful maybe because it facilitated that connection.”

 

“Other people may trigger different parts of us that give us an opportunity to learn about our inner processes.”

 

“‘Self’ is the part of us that can see our own trauma without being re-traumatized.”

 

“Healing is a process of hearing out that inner dialogue. So we can really develop a relationship with our parts.”

 

“Sometimes spaciousness actually fosters connection because it allows us to see each other more clearly.”

 

“Parts are still there after the healing process. You’re not trying to get rid of them. You’re just trying to allow them to be seen and to play healthy roles that are playful, pleasant, and productive to a certain extent.”

 

Here are some highlights from their conversation:

 

Let’s talk about healing. That’s where I wanted to go next. You said things like, ‘this part needs to tell their story.’ And you gave the example earlier about, maybe someone coming to therapy because they feel confused about whether to stay in or leave a relationship. And that the purpose of the therapy is not to arrive at a conclusion, but to create space for these stories to be heard. Can you tell me what’s healing about having these parts express themselves?  

It’s the beginning of the healing process. So I think that what’s healing is the self to part relationship. And so that relationship gets built based on the part being able to tell its story without causing a reaction or without having repercussions. So creating a connection between the self and the part by listening to their story is an essential step in the process of building those relationships.

We have a number of heuristics which are actually helpful. And if I can digress a bit, the founder, Rick Schwartz, in his most recent iteration of his book with Marta Sweezy, said that IFS could be conceived of as a psychodynamic theory. And so it is in this lineage of psychodynamic process. And because it does embrace the multiplicity of the mind, it allows for conflicting, psychodynamic relationships within the person.

What I like about IFS is that it goes one step in the direction of giving us tools for uncovering exiled or subconscious material. And so a classically trained psychoanalyst might expect to spend hours or days or years listening to the client on the couch, and eventually the subconscious material will bubble up, either in terms of dream interpretation or day time fantasies or behaviors that create ambivalence within them. I mean, they’ll just wait for it. And I love that idea of just waiting, witnessing. And so I have great respect for thoroughly trained psychoanalysts.

And IFS does give us some tools that allow us to move pretty quickly toward uncovering subconscious or exiled material. And so it has a toolbox that allows us to be expeditious. But I don’t think the process is very different from what a psychoanalyst would do. It’s just a little more guided and a little more intentional.

So one of the heuristics that IFS has is called the 6 F’s, and so I can walk us through those. You want to find parts. So whatever part we want to find, we want to see what’s up for the person. It might be that a single part has very strong feelings that need to be heard out. Or there may be a pair of parts that want to stay in or want to get out, a polarized pair of parts. So you want to find the one or two or three that you’re going to work with on that day. And then you want to focus on them, let them know that you’re here to listen to them. And when I say you, it’s actually the client ‘self; is there to listen to them. Now, the therapist’s ‘self’ energy is also very important in this process, so that the therapist ‘self’ and the client ‘self’ are there to listen to the parts. So, you know, it’s intuitive that that’s reassuring. I mean, if you’re wanting to make friends with someone, what do you do? You focus on them. You look them in the eye and you focus and then you flesh out.

So that’s the third F. ‘Tell me more about that. Tell me what that was like for you. Tell me what was the worst part of that or the best part of that? What did you do with that?’ And then there’s this phrase that we use is, ‘how do you feel toward the part?’ And that’s actually a key step because, you know, if you asked me, Bob, ;how do you feel toward that part that’s carrying shame?; And if I say something like, ‘well, I actually dislike that part, it’s annoying. It bothered me my whole life. Why would I be ashamed of it?’ Those are not self qualities. So what that tells you when I answer that way is that it’s not a self to part relationship with being developed. You’re hearing from another part of me that is trying to exile that part carrying the shame. And so you would at that point having asked me how I feel toward the part, but having not heard from self, you would say, ‘okay, can you give attention to the part that wants to get rid of that shame and let’s find out about it. What is it trying to do? What is afraid will happen if we heard  about the shame? What would it rather do if we didn’t have to suppress that part that had all the shame all the time?’

And, you know, and so we change the focus to the part that came up in reaction to the other part, and we continue to do that. And then we’ll ask, ‘how do you feel toward that part that wants to get rid of the shame?’ And, you know, at some point I’ll say, ‘well, I’m curious about what is it trying to do? And I want to know more. And  that’s self energy. And so then that’s our green light to start doing the real work of developing self to part relationships. So the feel toward is one of 6 F’s.

And then and then you want to unblend as much as possible. You want the part to be able to see the self, and the self to see the part and and parts don’t like doing that. They like being connected to self. They like being connected to self so much that they stick to self, like a glove. And so one thing that I like to say is, ‘can we ask the part to give us some distance and spaciousness so that you can see it better and so it can see you better?’ So one of the beautiful things about connection is whether it’s between people or within our parts, within ourselves. Sometimes the spaciousness actually fosters connection because it allows us to see each other more clearly. And then, you know, that can be healthy and relationships as well. Sometimes that relationship I mentioned earlier, ‘do I stay and do I go out?’ Maybe there is a middle ground. It’s, you know, let’s just take some space and, you know, we don’t spend  every day of our lives together. But we think we can walk and have some spaciousness. And that may be all the relationship wants or needs.

And it’s the same way within parts within ourselves, but sometimes asking them to unblend, they’ll say, ‘no, no, I cannot unblend.’ They’re desperate for more attention. But they said, ‘Well, no, it’s if you just give us some space, then I can see you better. You can see me better.’

So there’s unblending and then there’s befriending, just continuing to say, ‘it’s so great that I’ve been trying to protect Bob from feeling shame. You’ve done such a great job. And look how well he’s done in school and that has led to a career. And that’s so great.’ But do you really want to keep doing that all the time? And often they’ll say, ‘No, I’m exhausted.’ I’d rather that Bob, if there were a way for Bob to deal with his shame without me having to work all the time, I would like that, but I don’t think there is a way to do that. That’s why I’ve constructed this job. So the part may say that. You could say, ‘well, you know, I think there is a way to help Bob with the shame without you having to work all the time.’ Sometimes the part would say, ‘I’m not sure that’s possible, but I would want that. So, you know, let’s give that a try.’ And then you can ask, you know, that protective part to rest and it can stay close and watch if it wants, just in case something comes up that makes it afraid. It can step back in if it needs to. But that then gives you an opportunity to go back to that exile, which initially caused the protected part to come up. But that part now is befriended and it’s willing to rest. And so you can work with the exile material.

And then ultimately you would want to get to a point where whatever caused the burden of shame to come to that exile part, then that part can have a chance to leave that situation and unburden that shame. And then the whole system can appreciate that , ‘Yeah, there was a way to deal with the shame that didn’t involve having to compulsively work all the time.’

So the healing process is really one of befriending the parts and airing them out and ultimately giving the exiled parts a chance to be retrieved from the hard situation and then to unburden the beliefs that were important to survive that hard situation. And then to have the rest of the parts come back into the situation, and ask them, ‘did you see what happened there?’ And some of them will come back in and say, ‘oh, yeah, wow, I’m impressed. I didn’t think there was a way to solve that problem. But yeah, there was.’  So great.

And some of them may come back and be a little frightened. Like the example I gave might say, ‘you know, I spent my whole life working obsessively to do well in school. And now what do I do? I don’t know what my job is.’ ‘It’s okay. You know, I’ll work with you. There’s lots of jobs that you could do. Maybe you can work on writing a book or something other than school.’ Maybe oftentimes the job that the protectors want to do has nothing to do with what they were doing. The part of me that wanted to do well in school might want to take up finger painting or, you know, writing poetry like I was doing in college. Maybe they want to go back and do that or, you know, like, hey, who knows? But letting them do what they want, it’s an important part of being a good self for them, a good self leader for them.

I mean the parts are there, they’re still there after the healing process. You’re not trying to get rid of any part. You’re just trying to allow them to be seen and to play their healthy roles, which are roles that are playful and pleasant and productive to a certain extent.

 

Connect with Dr. Robert Grant on the Healing Realms Center website.

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Episode 30: Emotion and Transformation with Dr. Les Greenberg

 

“The best way to change an emotion is with another emotion.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Les Greenberg, a world renowned psychotherapist and researcher. He is one of the creators of Emotion-Focused Therapy (EFT) and professor at York University in Toronto. EFT centres around utilizing emotion to transform emotion. It is a different approach from the current major schools of psychotherapy like Cognitive Behavioural Therapy. He is also the founder and director of the Emotion-Focused Therapy clinic where he provides therapy for individuals and couples and trains therapists in EFT.

Dr. Greenberg is the author of 17 books like Changing Emotion With Emotion and Emotion-Focused Counselling in Action. And he has published over 100 scientific papers and has written over 80 book chapters.

Dr. Les Greenberg and Dr. Joe spoke about:

Connect with Dr. Joe on Facebook, Twitter,LinkedIn and Instagram

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Here are some highlights from their conversation:

You’ve spoken about the idea of the importance of using emotion to transform another emotion. Can you speak to why that is important and how that works?

My contention is that amygdala-based painful emotions like core fear and core shame are impenetrable to reason. You can’t reason somebody out of these core painful feelings because emotion is a whole embodied experience. And you’re organized to run away. You have a sinking feeling in the stomach. It’s not produced by cognition. It’s produced automatically by the activation of emotion schemes.

We have to find a way to work with these painful emotions and the best way to change an emotion is with another emotion. Spinoza was the first person to state a principle like this. He said, ‘the only way to change an emotion is with an opposing and stronger emotion.’

I think this can be thought of in primitive behavioural terms that some of the emotions are organized as withdrawal emotions. With fear, you run away. And shame, you shrink into the ground. Approach emotions like assertive anger or the sadness of grief, you really are moving forward and towards.

So if I have a client and I can take them to their core feeling of fear or shame and they’re organized to run away, then I can help activate assertive anger or the sadness in which you cry out for comfort or reach out for the lost object.

You can’t run away and thrust forward at the same time. So we’ve now got two opposing action tendencies. The new action tendency is going to transform the old one.

Hebb stated the first law of neuropsychology as “neurons that fire together, wire together.” So if you think of emotion as an emotion scheme, a network that fires. So when you fire shame and at the same time, simultaneously, you fire off anger.

Let’s say you have a drunken, physically abusive father. When you first imagine him in front of you in an empty chair, it fires off these feelings of fear and shame and you shrink and you want to run away. But then if I can help you to feel assertively angry–’I should have had a father who treated me right. I deserved to not be abused’–it generates assertive anger. ‘I’m angry at you for having treated me so unfairly.’

Now this new emotion undoes the old emotion. It doesn’t replace it. It actually transforms it and synthesizes with it to develop a truly novel experience. So your self-organizing system is re-organizing. And maybe the shame, the anger synthesizes with the shame to produce confidence or security or calm or something new. And this is a developmental process.

And rather than thinking about it in learning theory terms like exposure leads to reduction. This actually comes from a Piagetian notion that the development occurs by the synthesis of co-activating schemes.

At a more practical level, the best way to change an emotion is with another emotion.

A Framework for Mental Wellness

Start building your own mental wellness plan with the ACT MATRIX.

From an evolutionary perspective, the primary role of the human brain is to keep us safe. Our brain evolved in times where physical or social threats often had life-or-death consequences. When scanning the past or anticipating the future, we developed an 80% negative bias to best avoid harm and support survival, but not necessarily to thrive and become the best version of ourselves. Despite thousands of years of evolution, our brain still reacts to threats in the same way, even if perceived threats are much less destructive than they were in the past. From tigers and hunger, our modern-day threats now include colleagues ignoring our comments in a meeting, being late to daycare, losing benefits at work, not being able to see family and the like.

Our primitive or mammalian brain, called the limbic system, is highly efficient to protect us from perceived threats. It has learnt to either fight, flight or freeze depending on the context and your conditioned responses.

When we feel threatened, the mammalian brain kicks in, often with inappropriate, self-preservation reactions that we later regret as they alleviate the short term discomfort or generate an immediate reward, but do not necessarily take into consideration what is most important to us in time or align to our deepest values. Rather, the brain is wired with these learnt behaviours from the past and will often repeat them again and again, just because they feel most natural to us, even if they no longer serve us.

We may often react automatically in a way that we later regret, if we were not able to manage our emotions to better utilize our more mature, wiser brain called the prefrontal cortex (PFC).

To access our more mature, wiser brain (the PFC), we need to take note of our limiting beliefs, fears and related mental models that are keeping us stuck in a place that no longer serves us, and redirect our responses towards what is most important to us. This is what ACT (Acceptance and Commitment Training) allows us to do: by noticing the unconscious patterns, we can make a conscious choice about our preferred responses, which will move us towards more expansive and constructive habits and behaviours. ACT uses evidence-based interventions grounded in mindfulness to increase mental and emotional skills for handling the difficulties that inevitably arise from life. Mindfulness is at the very root of this foundation as it is one of the catalysts for well-being. We explain more about our approach to the development of a healthier mind and the role of mindfulness in our article “Supporting healthy performance: Four pillars of well-being.”

With that in mind, we use a matrix adapted from ACT:

 

 

All day long, we’re either doing what we call “towards moves” or “away moves.”

TOWARDS MOVES refer to responding according to our values and behaviours, which will lead us towards what really matters to us, expanding our potential for having a rich and meaningful life.

AWAY MOVES refer to reacting with often unconscious and conditioned beliefs, thoughts, emotions that lead to behavioural choices that keep us at bay from whom we really want to be.

The less aware we are of what is driving our choices, the easier it is to lose sight of what really matters — and the more we get stuck and move away from what we really want and need for a thriving life.

A more meaningful and fulfilling life begins with clarifying what is important to us, learning how to mindfully disengage from habitual thoughts and behaviours that take us away from what’s important and choosing moves that lead us in a healthy direction.

Now, you can draw a blank ACT Matrix on a piece of paper and fill it up to start building your own mental wellness plan.

Teletherapy and Cyber Security

Important Disclaimer: This document is for informational purposes and general guidance only and is not advice on any specific regulatory or legal matter. Always consider getting qualified advice on the facts of any matter before proceeding.

In a world in the midst of the COVID-19 pandemic, therapists have had to adapt rapidly to continue offering psychotherapy. The main form of adaptation has been to transition to delivering  remote therapy, whether via telephone or video conferencing. Existing bodies of research have shown online therapy to be effective, but clients and therapists often still have concerns about privacy and security. Now is the time to directly address those concerns and it has fallen on me, as Numinus’s Clinic Manager to take on this challenge. My background as both a therapist and information technology professional helps me to understand and explain our approach to the delivery of remote sessions in the province of Quebec.

Numinus has always had a few therapists providing remote sessions to their clients; now it is the entire team. We have always abided by the rules governing the practice of teletherapy in our jurisdiction and will continue to do so. The Ordre des psychologues du Québec (OPQ), the governing body for psychologists and psychotherapists in Quebec, has produced several documents outlining the ethical and practical guidelines for remote therapy (in French only). I will briefly summarize these documents:

OPQ Guidelines for Psychologists/Psychotherapists practicing in Quebec

Encryption, End-to-End Encryption, and You

Encryption is a way to obfuscate the contents of a message, or video, so that only someone with the proper decryption key can undo the encryption and see the contents of the encrypted communication.  End-to-End (E2E) encryption adds an extra layer of security so that even the provider of the tool or service cannot decrypt the contents of communications, even if compelled to by law, or hacked by a malicious actor who inserts themselves as a “man in the middle” at the corporate level (e.g., at a software company’s servers that offer the teleconferencing solution).

The most common questions that arise from these guidelines relate to encryption. Does your therapist use a tool that encrypts your communication, preventing casual electronic eavesdropping by unsophisticated attackers? Good odds that the answer is yes, and at Numinus, we definitely do. All the tools listed by the OPQ use some form of encryption in order to prevent electronic eavesdropping.

PIPEDA, HIPAA, and Quebec’s “substantially similar” legislation

You may have heard people talking about various names for electronic privacy legislation passed in various jurisdictions and how they relate to remote practice. In the United States, there is HIPAA, in Canada there is PIPEDA. In Québec’s there is An Act Respecting the Protection of Personal Information in the Private Sector, An Act to amend the Act respecting health services and social services, the Health Insurance Act and the Act respecting the Régie de l’assurance maladie du Québec, all of Québec’s privacy laws relating to health records. The most important things to know about all of these laws, from Numinus particular perspective:

What you can do to help ensure that your sessions remain confidential

When it comes to security, you are more likely to have your remote session’s privacy violated by a person physically listening in from a nearby location than by a sophisticated state actor capable of breaking encryption or inserting themselves as a “man in the middle” attacker (e.g., the National Security Agency in the United States). The corporations offering these communication services have a vested interest, both legal and financial, in maintaining the privacy of these communications, so unless compelled by court order, they will not intercept any remote communications or turn over any recordings (which they all state that they do not even make in the first place). One could argue that you are as likely to have an in-person session bugged by law enforcement as to have a court order issued mandating that a session be captured and decrypted. If this is a real concern of yours, due to your work or other factors (e.g., you are a high level government official, famous actor, or crime lord), then online sessions might be best avoided! If you are not generally at risk of being a target of a state-level actor or law enforcement, you can also do some basic things to best assure your privacy:

  1. Make sure you are initiating sessions from a place where you can monitor, and ideally control, your environment to prevent someone from physically listening in.
  2. Do not use public WiFi networks when engaging in remote therapy unless there is absolutely no other choice. And if you must use public WiFi, then you must use a Virtual Private Network (VPN) software solution to provide an additional layer of protection to your communications.
  3. Regularly run virus and malware scans of your computer, or use your mobile device for your remote session, as they are far less prone to viruses and malware.

I hope this helps to inform you and address any concerns you might have, whether as a therapist delivering remote sessions, or a client on the receiving end!