KAP module 4 Trauma and Training of psychedelic-assisted therapists
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This document provides an overview of considerations for ketamine-assisted psychotherapy in treating trauma. It discusses types of trauma, stages of trauma recovery, and categories of working with trauma from a nervous system dysregulation perspective. It outlines pathways of healing trauma and a transpersonal approach. Key aspects of psychedelic-assisted therapy are described, including how trauma may emerge and unique preparation approaches. Ketamine is discussed as a trauma healing support agent, with specific strategies outlined. Long-term integration dimensions are presented. The document concludes with discussing trauma integration and connection to benevolent spirituality.
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KAP module 4 Trauma and Training of psychedelic-assisted therapists
- 1. POLARIS INSIGHT CENTER SAN FRANCISCO Ketamine-Assisted Psychotherapy Training & Consultation www.polarisinsight.com
- 2. Consideration in Treatment of Trauma with Ketamine –Assisted- Psychotherapy Harvey Schwartz, PhD and Veronika Gold, LMFT Polaris Insight Center
- 3. Introductory Themes • Brief History of PTSD and treatment of PTSD and trajectory of treatment approaches • Types of trauma – acute, chronic, moral injury, complex, developmental • Stages of trauma recovery – safety/stabilization, grieving, restoring/empowerment/integration • Traumatic transference traumatic counter transference
- 4. Categories of working with Trauma from Nervous System Dysregulation Perspective (Peter Levine, 2017 ) Global High Activation: Pre- Peri- Natal, Birth Trauma Early Surgeries, Anesthesia, High Fever, Suffocation, Choking, Drowning High Impact/Failure of Physical Defense: Falls, Head Injury, High Impact/Moto Vehicle Accidents Inescapable Attack: Animal Attack, Escape Inhibited, Rape/Sexual Abuse Physical Injury: Surgery, Poisoning, Burns Natural and Man-Made Disasters: Natural Disasters, Horror, Torture, Trafficking, Physical Abuse, Ritual Abuse, War Emotional Trauma: Humiliation, Devaluation, Domination
- 5. Pathways of Healing Trauma - Stabilization and Functionality - Debriefing and Supportive Therapy - Remembering, Uncovering, and Catharsis, Grieving - Exposure and desensitization - Cognitive reframing of believes, identity, and meaning - Affect regulation and management of triggers and intrusive symptoms - Reparative relationship experience - Transformation of shame, pathological guilt, and false identifications - Sensory processing, deactivation, and integration - Recovery of the symbolic realm of functioning - Restoration of the spiritual and access to transpersonal experience Y
- 6. Transpersonal Approach to Healing Trauma • Underlying Wholeness – Inner Healing Intelligence • Healing Through The Experience • Trauma can occur and heal on the different levels of experience • Therapist’s following is guided by the inner healing wisdom, is collaborative, equalitarian • Guidance and presence and bodywork vs interpretation, hierarchy, and emotional distance
- 7. Essence of Psychedelic Assisted Therapy • Reduction in depression and anxiety • Increased sense of well-being and increased optimism • Antidoting alienation and cultivation interconnectivity and sense of belonging • Expanding the Window of Tolerance • Activating Self-Compassion • Reparative relationship experience while reliving trauma and during integration • Somatic release, catharsis, discharge of trauma • Reconnection to the Inner Healing Intelligence • Value of transpersonal and archetypal experiences
- 8. How Trauma Emerges in KAP • Clients is aware of parts of the trauma and consciously seeks to explore more with intention and appropriate preparation • Sudden unexpected emergence of previously unknown memories in the body and mind • Abreaction • Somatic and relational reactivity/negativity/hostility focused on external or internal experience “not knowing why” • Plays out in transference and countertransference relationship • Dreams before or after sessions
- 9. Unique Approaches in Preparation • Dilemma in the field about appropriateness • Assessment evaluation of trauma education and support system • Discussion of the possibly long term treatment plan • Permission and protection about how trauma comes up and having collaborative discussions and problem solving • Preparing for ongoing meaning making and identity dilemmas, becoming comfortable with ambiguity and uncertainty and challenges to previously held world views • Bridging memory from previous session/s
- 10. Ketamine as Trauma Healing Support Agent • Minimal research has been done • Most focus is on symptom relief around depression and anxiety • Relaxation of defenses increase capacity for vulnerability and exploration in regular psychotherapy • Exposure therapy combine with IV Ketamine • Reconciliation with Trauma focused therapy that targets pathological memory formation/extinction learning
- 11. Specific Trauma Healing Strategies in KAP • Consideration of dissociative aspects of ketamine during interventions • Dose dependent interventions • Processing through direct experience • Processing with somatic interventions and support • Working with the fragility of memory – precise mirroring, note keeping • Collaborative and highly sensitive approach – intrusion vs abandonment • Titration and Pendulation in sessions (less in KAP) through collaborative approach with clients
- 12. Dimensions of Long Term Integration • Security, Safety, and Regulation (sensitivity to communities of oppression) • Sense of Control – beyond learned helplessness • Observing Ego - emotional distance from triggers, overwhelming emotions, and a sense of choice • Being in the Present – ability to differentiate between past and present emotions and situations • Self-care, self-compassion, and self-forgiveness • Ability to use community and other relational resources • Mentalization, self-observation, and reflection • Restoration of healthy and aggressive balanced energies • Restoration of restorative fantasy capacity and connection to the symbolic world • Empowerment and Sovereignty • Resolution of pathological shame
- 13. TRAUMA INTEGRATION CONNECTION TO BENEVOLENT SPIRITUALITY TRANSFORMING PATHOLOGICAL SHAME INTO DIGNITY AND SOVEREIGNTY RESTORATION OF NATURAL RESPONSES IN NERVOUS SYSTEM IDENTITY AND EMPOWERMENT
- 14. Becoming a Good Psychedelic Therapist
- 15. Should a Psychedelic Therapist Have Psychedelic Experience? CONS • No research to validate the necessity • Overwhelming need for therapists as soon as possible • Philosophical, Physical, Mental contraindications • Stigma/illegality/professional marginalization • Discrediting psychological research and findings • Peer pressure, bias, and coercion PROS • Increased empathy and understanding of protean nature of psychedelic experience • Aligned with shamanic traditions • Better ability to respond to and navigate challenging experiences • Aligned with requirements of most leading therapeutic schools (SE, IFS, EMDR, psychoanalysis, etc.) • Familiarity with expanded states of consciousness • Supports trust and understanding in therapeutic relationship • Decolonizing and depathologizing psychedelic therapy
- 16. Should a therapist have a KAP experience? 4 SELF experience YOUR therapist Therapist you refer to Not important 1/ 25% Beneficial 3/ 75% 3/ 75% 1/ 25% Essential 1/ 25% 1/ 25% 2/ 25% 22 SELF experience YOUR therapist Therapist you refer to Not important 1/ 4.5% 2/ 9% 1/ 4.5% Beneficial 4/ 18% 2/ 9% 4/ 18% Essential 17/ 77% 18/ 81% 17/ 77%
- 17. What was unique to KAP experience? “While it is never really essential to have a therapist go through everything you’ve been through in order for them to help you, a shared experience—psychedelic or not— gives me a deeper trust and bond in the therapist.” “I believe it is important for a psychedelic therapist to have some psychedelic experience as they can bring about journeys that can be both transcendent or profoundly difficult or both and it is beneficial for the therapist to have at least some experience of navigating these terrains. The ineffable quality of a psychedelic experience is one of its hallmarks and it benefits the therapeutic relationship for the therapist to have some firsthand knowledge of these unique states of consciousness.” “I think it would be very hard to support someone on this journey without having done it yourself. I would not want to work with any therapist who has not had their own therapy. And when we look into specialists, which a KAP therapist would need to be, they need to try it themselves to truly be a specialist.” “I think it's really important to help people get through any fears and to bring your own sense of the non-ordinary to the work. There's a trend towards treating this as medicine in the very straight, western sense, yet I think one of the main qualities of healing that k a p and psychedelics bring is a sense of dissolving boundaries between self and other, a sense of there being more than this "reality" and that we are more than our diseases, symptoms, dysfunctions. I think a therapist needs to have this understanding in order to offer the perspective to the client.” “Just as I wouldn't want to go to a therapist who never went to therapy, I wouldn't want to go to a KAP therapist who didn't have some personal experience with the medicine.” “I think it’s essential for purposes of energetic/spiritual connection between therapist and client.” “The experience is so unique and life-changing, I would want my therapist to understand what it is I went through.” “For one thing, it is essential for trust building that the therapist guiding the ketamine session have some experience of that space in order to speak with both compassion and authority. I also think that ketamine is such a unique medicine and provides such a different space that it is important for the therapist to have some knowledge of that in order to be able to guide and navigate with the client effectively.”
- 18. Why would it be important for therapist to have the direct experience? “Ketamine has for me a texture and a dynamism that it's unique to this medicine. There's a lot of movement that I experience, like I'm on a means of transportation traveling through different environments. The experience of dissociation from my body is also very unique. The visuals have a different textures from the other psychedelics. Music sounds deconstructed. I hear every single note and every single instrument separately.” “Realizing you could access the same hyper-psychedelic "breakthrough" space using intramuscular ketamine as you could when using DMT was a revelation. This is not the same space as say using LSD or psilocybin. And the sense of ego dissolution was immense. Very important for the therapist to experience for themselves if they are to truly understand what can happen in that space.” “Ketamine is a completely unique space unlike other psychedelic experiences. It can be difficult and slippery to describe and is best experienced. The rapidity with which ketamine imagery and a journey can move is unique to ketamine.” “It was very peaceful and I experienced death. I have thought about death with other medicine experiences but never actually experienced it.” “For me, having direct, visceral experience of the medicine helps me connect energetically to the patient’s experience. Knowing how deep and profound the ketamine experience is allows me to hold a particular reverence for it. Instead of simply being an RN who is delivering an injection, I see the energy I bring to the interaction as a key element. Before experiencing ketamine I held an unconscious bias against it. In some way, compared to psilocybin, I viewed it as “not a real psychedelic.” I thought of it as more medical than spiritual. It has been really important for me to know, firsthand, that ketamine is in fact very spiritual!” “The arc of a KAP session; the near death aspects unique to ketamine; the short duration of effect and understanding how that affects pacing and timing of a session; the navigation of after abs side effects; handling rapid opening and tendency to rapidly return egoic thinking; facing unformulated ambiguous bliss and challenging experiences; familiarity with variations on unique somatic and vocal reactions with ketamine so can handle the process with patients; understanding rapid onset quick (IM) ego dissolution so able to guide prep and hold space better and supply educated reassurance and perspectives on process.” “The phenomenon itself of ketamine is extremely difficult to describe as it is quite sensory and ineffable, more so than other trans personal experiences I’ve had. So having ones own experience is essential for communicating, or tolerating and supporting lack of communication about clients’ experiences.”
- 20. The Competencies of the Therapist Guide for Psychedelic-Assisted Psychotherapy Phelps, 2017 Competency 1: Empathetic Abiding Presence Competency 2: Trust Enhancement Competency 3: Spiritual Intelligence Competency 4: Knowledge of the Physical and Psychological Effects of Psychedelics Competency 5: Therapist Self-Awareness and Ethical Integrity Competency 6: Proficiency in Complementary Techniques
- 21. The 12 curricular domains of study for training in psychedelic-assisted psychotherapy (Phelps, 2017) 1. The history of clinical research and current legal status of psychedelic-assisted therapy 2. Neurobiology, neuropharmacology, drug disposition, and drug interactions 3. Best practices in sets and settings: preparation, psychedelic session, and integration 4. Psychedelics and therapeutic relationships: transference, boundaries, ethics, and self-care 5. Supervised observation of psychedelic session videos 6. Variations in therapeutic models: client-centered and psycholytic psychedelic therapy 7. Complementary therapeutic techniques in psychedelic-assisted therapy 8. Co-therapy methods and interprofessional skills for working on multidisciplinary teams 9. Current models of consciousness, spiritual intelligence, and mystical experiences 10. Ceremonial use of psychedelics in religious and community settings 11. Individual and group clinical supervision during an internship as a psychedelic therapist in FDA-approved clinical trials or expanded access clinical research programs 12. Personal experience of being guided as a research participant in an FDA-approved study
- 22. What constitutes being a good psychedelic therapist???
- 23. • Ongoing commitment to doing your personal work • Be comfortable with your own suffering so you can be comfortable with various forms and expressions of suffering of others • Become committed to developing your clinical skills and wisely and creatively use professional consultation • Increase your sensitivity to cross-cultural, gender, interracial, LGBTQIA effects on the healing process • Obtain training in somatic, touch, bodywork • Obtain training in complex PTSD and dissociative processed and their effects on attachment, aggression, and fantasy, and identity • Increase your self care, take it SERIOUSLY • Direct experience of psychedelics, altered stated, and NOSC • Cultivate community and avoid isolation, burn out, overwork, boundary collapse/overcommitment/overextension
- 24. • Understand the set and setting variables, particularly attitudes and mindset • Understand the importance of preparation, iterations of informed consent, and true collaboration • Understand to practice non-hierarchical and collaborative forms of therapy, respect egalitarianism, mutuality, without loosing benevolent authority of the therapist • Understand the nature and power and potential of NOSC/holotropic states in healing, and their place in cross-cultural/spiritual traditions • Understand the healing process in non-linear, non- predictable, chaotic, and full of unexpected surprises • Understand the importance of music/different types of music/playlist • Understand how to work with touch, its benefits and pitfalls
- 25. • Understand and be able to communicate the significance of inner healing intelligence • Understand the radical shifts in temporal perspective take place in non-ordinary states • Understand the potential value of “challenging experience” • Understand the value process and potential pitfalls of the integration process, particularly the extremes of inflation and negation • Learn how to use blended treatments as IFS, EMDR, SE, ACT, Hakomi, Breathwork, Yoga – yet avoid becoming technique driven when feeling anxious or uncomfortable • Benefit of additional healing modalities as energy work, sound healing, acupuncture/acupressure points • Understand how transference and countertransference are effected by psychedelics and NOSC • Understand and learn to work creatively with the complex dynamic of shame especially in post- traumatic conditions
- 26. • Help Clients feel safe, cared for, understood and accompanied on their path • Understand the value of sustained compassion with consistent focus on the present experience ”including vocal posture and somatic shifts” • Appreciate the different forms of listening: Psychoanalytic, Interpersonal, Somatic, Archetypal, Intuitive, Energetic • Appreciate the value of play, pleasure, and comedy, and joyful experience in the healing process “not as avoidance, indulgence, or distraction” • Find ways to effectively communicate with clients about the non-linear nature of the healing process • Understand the value of presence, witnessing, containing, and providing a solid, flexible, creating, and consistent holding environment • Understand the non-unitary nature of the self and how to work with multiplicity • Learn how to work effectively in co-therapy, avoiding pitfalls of competition and abdication behaviors
- 27. • Continue to reflect on W.A.I.T. - Why Am I Talking/Touching now? • Be wary of excess verbal and intellectual processes especially when disconnected from body awareness and emotional processes • Learn to work sensibly and creatively with dynamics of idealization and devaluation • Understand when to take risks with clients, especially when to amplify, intensify and when to remain still, and let the client’s reparative consciousness do the work • Become increasingly aware when the urge to comfort is actually an avoidance and distraction and infantilization • Be wary of taking too much responsibility for clients and not creating a shared sense of mission, collaboration, exploration; learn how to work with client’s avoidances and insistency
- 28. • Learn to balance the pulls of dependency and autonomy in the psychotherapy process and become aware of your tendencies and beliefs in the area • Appreciate the paradox that following can be another way of leading • Become increasing comfortable with the experiences of not knowing, confusion, and overwhelm; let ”I don’t know” become a more frequently used and legitimate intervention • Stay engaged and involved in ongoing conversations about the development of psychedelic assisted therapies and their integration in the western medicine model; be continuously engaged in the conversation on ethical issues, cultural honoring, and standards of treatment
- 29. Polaris Insight Center 4257 18th St. San Francisco, CA 94114 415.800.7083 polarisinsight.com [email protected] [email protected] [email protected] THANK YOU