Psychedelic Psychotherapy

With all the massive upheaval occurring in the world, our normal patterns of defense and adaptation are breaking down. Many people are seeking to return to how things were, or seeking a new normal. This upheaval is a catalyst that exposes many underlying structural pathologies in our individual and collective psyches. It is as if we are all in a dream together, and we need to become lucid before it veers out of control into a nightmare scenario. The teeter totter of consciousness often goes back and forth between denial and despair. We must learn to embody the space between the two, so that we can clearly see that which usually sends us spinning out. If we we can do this we can stay connected to the hope that is critical to move forward.

Psychedelic Psychotherapy has the potential to move us closer to the space between denial and despair. We can begin to see what is happening, without being overwhelmed by it. This embodiment of the space between hope and despair can also occur in high quality psychotherapy without the assistance of psychedelics. But the process can be slower for many, and the addition of psychedelic compounds into treatment creates a demarcation point and importance into the experience of therapy that sometimes is lost in other forms of psychotherapy.

Currently, the only legal psychedelic for prescription use is Ketamine. Ketamine is ideal in some ways because of its short duration of action and safe side effect profile. I work with Ketamine in a way that is deeply rooted in the healing of trauma and metabolization of the underlying cause of depression and anxiety. If you already have a therapist you are working with, we can collaborate and utilize a team approach for your treatment.

Mental Health and Covid-19, Intersecting Wicked Problems

One way of understanding complex problems is through the lens of Wicked Problems. Wicked Problems are multidimensional and have numerous causes, symptoms, and potential solutions. They cannot be definitively delineated or demarcated because many stakeholders frame the problems within different world-views. Wicked Problems can be considered a symptom, as well as a cause, of other problems, and even of themselves. Wicked Problems are complex and consequential, yet solutions are hard or impossible to test accurately. Wicked Problems have a tendency to fester or get more severe over time, with nothing automatically stopping their vicious cycles or intensifying feedback loops. ​With Covid-19 and Mental Health, we have two intersecting Wicked Problems.

Mental Health refers to a human being’s subjective experience, that which is most personal, including perceptions, thoughts, sensations and emotions. Our thoughts, emotions and perceptions are interwoven with our social and physical environments into an intersubjective lattice that makes up the consciousness of humanity. As the Mental Health treatment system has been constructed, we too easily see mental illness as problems of the individual, instead of the systemic, political, cultural, and familial problems which they truly are. We tend to hyper-focus on the individual and become blind to the larger context, the proverbial missing the forest for the trees. This hyper-individual focus is both a symptom and a cause of most Mental Health issues, including the shortcomings of the Mental Health system at large. It’s critical to have a binocular vision which includes both system and individual, both forest and tree when trying to make sustainable change.

The wicked nature of Covid-19 is evident in its multidimensionality. The disease exists on the level of virus, cell, immune system, individual and economy and culture at large. The Wicked Problems of Covid-19 and our Mental Health issues are mutually constituting. The way of life for much of western society was not Mentally Healthy to begin with prior to Covid-19, with Mental Health being defined by numerous factors including rates of suicide, rates of antidepressant and antipsychotic prescriptions, wealth inequality, atmospheric carbon levels, etc. People with pre-existing medical conditions are the ones that are most vulnerable to the effects of Covid-19, and cultures and nation states with the least amount of resiliency and health are the most vulnerable to the macrosystemic effects of this pandemic. And in this way, our culture’s way of of life has contributed to our vulnerability to Covid-19 as a society, while our response to Covid-19 is exacerbating our pre-existing Mental Health issues.

The Mental Health issues of individuals in these times can not be separated from the suffering people are experiencing due to lack of purpose, social and economic hierarchies, lack of connection, lack of economic security, and increasing proximity to mortality. All of these things cause anxiety in individuals and cultures as a whole. To isolate the ‘individual’ from the socioeconomic and cultural components of Mental Health is both a symptom and a cause of the deeper Mental Health crisis itself. For example, this occurs through the forced treatment of adolescents. Adolescents are some of the most vulnerable people to the cultural shifts imparted by Covid-19. The dominant model of mental health localizes the problem to the individual adolescent, and more specifically into their brain. Many teenagers experiencing depression and anxiety in these days continue to be treated independent of their family system, although it is abundantly clear that the problems that teens are facing are cultural, familial and systemic in nature, and do not live solely within the teenage brain.  

As a psychiatrist working with individuals, families, and couples, I am involved in a system that perpetuates a mythology of individual mental health issues separate from cultural and systemic health. Seeing people in a one-on-one setting perpetuates the myth that individuals are the ones with the problems. Ketamine-Assisted Psychotherapy, one of treatments I specialize in, does allow deep and fundamental changes to occur for individuals, but it’s unfortunately limited to the individual. And though helpful, does not contribute much to the larger systemic shifts that we need for societal and individual health.

The real treatment we need to address our chronic mental health issues include structural change at the level of politics, culture, education, families and systems of care. We need our social structures to evolve into systems that are truly based in care and empathy as well as the meeting of actual human needs. A movement towards a caring socioeconomic structure is one that can cross the political divide. The places that this can most readily happen is in our proximal social circles, which for the majority of us include family, friends and colleagues. If we can bring virtuous cycles of care into our personal interactions and extricate ourselves from vicious cycles of blame, then we can begin to contribute to a shift towards systemic health. So yes, change starts with the individual, though not with one individual, but with numerous individuals within a system. And, iff we attempt to force change in others, we inevitably will be faced with the unintended consequences of our force, even if it was well-meaning.

My prescription for improving Mental Health is not as simple as taking a daily antidepressant, or doing a 30-day treatment program. The mental health crisis caused by, uncovered by, and contributing to the Covid-19 pandemic and socioeconomic collapse can best be treated by addressing our basic needs while helping others to meet their basic needs, as well as through processing the trauma that has contributed to the ongoing isolation and lack of safety that is at the root of our Mental Health issues. Skilled Mental Health practitioners are needed not only to help people process their trauma and facilitate therapeutic relational experiences, but to also create systems of care that can steward that process on a larger scale. We need to begin to create real Community Mental Health centers, one’s that are focused on community mental health more on substance than name. Wicked Problems such as Covid-19 and Mental Health tend to get oversimplified, but if we can calmly engage the complexity of the topic, we often see that the solutions are hidden in plain sight within the problems themselves.

Attachment Based Family Therapy

Attachment Based Family Therapy (ABFT) is one of my primary frameworks for working with teens. One of the keys to ABFT is to reframe the presenting problem as a relational one. Too often the ‘troubled teen’ is the sole focus of therapy. But ‘troubled teens’ don’t manifest in a vacuum. The choices, circumstances, and relationships the teen has had plays a major factor in how they are doing on a day to day basis. ABFT creates a framework where I can develop a strong alliance with both teen and parents, and leverage the relationship as a force for growth and regeneration. Relational approaches to family therapy require a strong emotional investment and high level of self-responsibility from all participants. The work can be challenging, but the rewards can be a transformed relationship, which is what mental health is ultimately all about. To find out more about ABFT listen to this podcast by the creators of the model.

Ketamine and Neuroplasticity

New Research continues to come out regularly showing the benefits of Psychedelic Assisted Psychotherapies. This study coming out of UC Davis talks about changing the name of the class of medications to ‘Psychoplastogen” because of the increase in neuroplasticity associated with these substances. Neuroplasticity is the term to describe the brain being able to change through making new synaptic connections. Ketamine is one of the many substances known to increase neuroplasticity. The key to utilizing Ketamine and similar substances involves making changes in your patterns of thoughts, behaviors, and perceptions in conjunction with treatment. This is one of the reasons Ketamine when combined with Psychotherapy can make sustainable changes in your life.

Who we treat and why.

At Insight Psychiatry we primarily work with Adults in the context of Ketamine Psychotherapy. The need for this approach to Psychotherapy for outweighs its availability. Most psychiatrists utilize an epistemological framework based on the chemical imbalance theory of depression. Here we utilize a developmental perspective which focuses on the experience we have had in our lives which form our current worldview. We believe it is experience that makes us, and experience that changes us. Ketamine Psychotherapy provides an experience that can improve our neuroplasticity and make one receptive for experiential changes.

We also see couples and families because of the massive need for relational and systemic changes families and couples have. Relational and systemic approaches to therapy are lacking in the psychotherapeutic community. By working with couples and families, the changes that need to occur for mental health to improve can be sustained systemically.

An antidepressant, or a yak?

"A rose by any other name would smell as sweet" -Shakespeare

Something that we do not often think about when taking psychiatric medications is the effect of how our beliefs shape our experience with medications. In the book Lost Connections by Johan Harri, he tells a story of a man who lost both legs while working the fields in a rice paddy in Vietnam due to an unexploded land mine. The man was extremely depressed, and the local physician said he was treated with an antidepressant. When asked what type of antidepressant was prescribed, the physician said that a yak was prescribed. This led to some confusion, but as the story unfolds, the Yak gave this rice farmer an new livelihood, and a new purpose, and his depression resolved. Antidepressants don’t always have to be pills, sometimes they can be yaks. The name we give to things, have an incredible impact on how something is experienced.