“Watch out now, Take care, beware the thoughts that linger, Winding up inside your head, The hopelessness around you, In the dead of night…Beware of sadness”
(From George Harrison’s “Beware of Darkness”)
When last we left the wonderful world of Integrative Mental Health Care, we had become familiarized with the natural pairing of ketamine-assisted therapy and the evidence-based Internal Family Systems (IFS) model of psychotherapy — an honest-to-goodness power couple if ever there was one because of its potential for helping heal depression, anxiety, and PTSD (and possibly other mental maladies that one may be struggling with). If all other traditional avenues of quelling your restless psyche have fallen way short and you’re on the verge of desperation, Psychedelic integrative therapy may very well be (or could be) in your future.
If there is one thing that any reputable mental health professional can agree on it’s that psychotherapy — getting to the root of what ails your squirmy mind through discussion and self-analysis — is the only real way of helping you heal. Easier said than done.
The ritual of “preparation and integration” has become vital in the before and after ketamine assisted therapy experience. Considering that each client’s reason for seeking this kind of therapy is very different, the experience during a non-ordinary state of consciousness can be either extremely curative, or it may be somewhat disturbing. That’s why medical professionals, as well as those immersed in the field of psychedelics, are quick to stress that ketamine isn’t for everyone.
The “pregame session” of talk therapy (psychoanalysis) helps you understand that depending on your experiences in life, whatever trauma may be lurking in the recesses, you need to be prepared for anything — good or bad. Full disclosure is an absolute when dealing with psychedelics. The Integration (post-game) is the fusion of the mind and body following the experience of a non-ordinary state of consciousness prompted by the ingestion of psychedelics (in this case, ketamine). It is the process of exploring and sharing any confrontations or insights that came up during your psychedelic experience.
Any emotions, sensations, or ideas elicited during your ketamine or other psychedelic experience can be meaningful for the process of healing. Integration is about creating the space in your psyche to “make meaning” of those feelings, sensations, and ideas so that they can help you function day-to-day. In a nutshell, integration therapy increases the potential for personal transformation that psychedelics offer.
Seeking professional support can make a huge difference between successfully integrating our new insights into our lives in meaningful ways or stopping short of any lasting healing and growth.
The pairing of ketamine and IFS (Internal Family Systems) has become an attractive mode of “getting there” — to that place in your psyche. While the ketamine lowers the wall of natural inhibition and fear to identify the seed, or “part,” that’s causing your mental torture, it’s the IFS therapy at the end of the ride that helps you to speak to that part once and for all to find out what it needs you to know (this is the Integration part).
In the interest of perspective, a few clients of Prudy Carter Donovan agreed to speak with me about their respective experience(s).
Pauline Amar Freedman of Chilmark began our conversation by stating that her diagnosis was PTSD. “I just thought I was depressed. But I also had a lot of self-hatred and this endless mind loop of ‘What’s wrong with me? Why can’t I get my act together? Why do I always end up back in this place?’ I struggled with depression for years, took every anti-depression medication that was out there — some helped for short periods of time. But nothing ever really diminished the feeling I had of ‘What was wrong with me?’ Being an overachiever, nothing ever felt good to me. I became a lawyer and hated it. Worked for a nonprofit, liked it for a while then I didn’t. Then I discovered yoga and meditation, and that made a huge difference in my life. It helped me get to a place where I could identify my triggers and keep myself well-regulated. Whenever I would feel angry or depressed, I would use yoga and meditation to help put me in a better place. But the fact remained that I was still getting triggered. Other people might not have been able to tell I was triggered, but on the inside the self-hatred and suicidal ideation was there.
“Now that I’ve gone through the Ketamine Therapy, the triggers just aren’t there anymore. Like the first time I experienced something that would’ve ordinarily elicited that old familiar negative reaction – a feeling I was so very used to, this is after I went through the therapy, that is, it didn’t happen, it wasn’t there anymore. The ketamine helped give me an immediate lift out of the darkness.”
But we need to remember that it is called Integrative Mental Health Care.
Pauline continued.
“Prior to the administering of the ketamine, Prudy led me through some preliminary IFS (Internal Family Systems) therapy. IFS therapy is a huge component in this whole process because you have to access parts of yourself that you wouldn’t ordinarily access if you’re just talking. With IFS, you are given time to connect with your ‘parts.’ Before the administering of the ketamine, I found it very difficult to connect with my parts — I just wasn’t sure what I was feeling, or if what I was feeling was actual. However, my post-ketamine self felt a lot more at ease to connect and identify the part or parts that caused me to feel bad.”
According to Pauline, the ketamine essentially pried the door of inhibition wide open so that she was granted access to the troubled part that was making her feel grim.
“For example, I’m a high achiever. It’s a trait that society not only condones, but encourages. I would often wonder ‘If I’m not accomplishing something, who would I be?’ And when you’re going through the IFS part of the therapy, you begin to realize that that is not who you are — it’s just one part of you. Once you identify that part, you can then communicate with it. Just as importantly, that part can tell you what it needs from you. It’s a dialogue.”
Pauline now says that she feels joy on a daily basis. While she still has her ups and downs, they are nothing at all like they were. The recovery time from a down moment now is exponentially quicker. But she is quick to emphasize that “the IFS Therapy is just as important to the sessions as the actual ketamine injection.”
When she was initially asked to participate in this article, Pauline didn’t hesitate to point out that “If my sharing my experience can help one other person get out of their darkness, then I feel like I’ve done a good deed.”
Retired Harvard Business School professor and Chilmark resident Richard Hamermesh is another who has gone to Inner Journey Wellness for healing.
Before he discussed his experience, Richard offered up this preamble:
“I want to self identify as not terribly depressed or anything. I’m more of a high functioning neurotic who’s done a fair amount of traditional talk therapy that’s been effective to the extent that it helped ‘move the vector’ 10 to 15 degrees. But then it got to a point where it wasn’t going to move any more. I reached the moment where I said to myself ‘How much can you keep talking about your mother?’”
Richard was adamant about not wanting to be any kind of focal point in this article. But his perspective, not to mention his background in the biotech community in Boston, made it inevitable that his voice was an important one in the advocacy for this new integrative health care model.
“My goal was to get on the other side of some issues I had dealing with moods and so forth, and ketamine — juxtaposed with the IFS model of psychotherapy — was very effective. In fact, going through the pre-ketamine IFS protocol essentially primes your mind for the ketamine. To contrast this with anyone’s casual, recreational psychedelic experience when you’re out communing with nature or dancing around a fire or something, the goal is to go inward to become acquainted with the part that is irking you and causing you to feel badly.”
Richard continued.
“I’m very aware of drug approvals and off-label use, and if you follow this at all you have to be intrigued that people who are very depressed, or women with Anorexia Nervosa, folks with PTSD, they’re getting initial case reports of people with great results from these seeming ‘alternative treatments’ like ketamine and entheogens (psychedelic substances) in a clinical setting. It’s been three or four months since my last ketamine treatment and the effects are still with me. For example, it’s not like I don’t get angry anymore. It’s just that the feeling, that intensity, is much more muted. I have a feeling of pause in the moment. I think ‘Is this really worth getting upset over or arguing about? Can I express this anger I feel in different ways?’ It allows you to see your issue for what it is.”
Which begs another argument — one that Richard lends his professorial/client voice to:
“Just from an efficiency point of view, wouldn’t it be better to undergo a proven treatment — one that’s helped you like nothing ever has — and possibly have to follow up with a booster or something every three of four months or not at all? Or would you rather continue your current, ‘marginally helpful’ regimen of taking a pill or two every day for the rest of your life?”
Both Pauline and Richard, interviewed separately, concur that with the inclusion of the Internal Family Systems model of psychotherapy, long-dormant “parts” suddenly began to manifest — pivotal moments in their life that they hadn’t thought of in years.
“It’s all in the cumulative approach of the six sessions,” says Richard. “If there is a very important subtext to this, it’s the opening of new neural pathways. Especially as we get older, we are very ‘hard wired’ to be or react in a certain way. A lifetime of learned behavior needs a special kind of environment to be unlearned — especially if it’s been affecting you negatively.”
“Taking an Inward Journey” is the second in a three-part series about some non-traditional, integrational healing modalities. Next month we’ll hear from Betty Aldworth from MAPS, the Multidisciplinary Association for Psychedelic Studies. She’ll discuss the next major FDA approved, highly successful treatment for PTSD, as proven by clinical trials, we can expect to be available within the next 18 months or so.
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Since the Internal Family Systems Model of psychotherapy is utilized for the preparation and integration part of ketamine-assisted therapy here on the Vineyard, I had to call upon my own psychotherapist, Deborah A. Withers (MSW, LICSW, EMDR certified). She was based in West Tisbury for years until she and her family relocated to Kapaau, Hawaii, where she continues her practice (as well as by telemedicine). Following a pretty devastating automobile accident in 2014, Deb’s utilization of IFS helped our family immeasurably over the past nine years. Apart from the trauma of the accident itself, we’ve unearthed a lot of things about ourselves, gotten in touch with those parts of ourselves that haven’t really served us positively, and “unburdened” quite a lot of trauma.
Deb’s inclusion in this series was a no-brainer.
It became clear very early in my work with clients struggling with complex PTSD that methods I’d learned in graduate school were not making much of a difference in symptom reduction and suffering. I went on a search for models to really heal the trauma that they carried. I studied Hypnosis, Dance Movement Therapy, and Reiki, knowing intuitively that “The Body Keeps the Score” as Bessel Van Der Kolk wrote in his important work on treating trauma. I also kept hearing about EMDR (Eye Movement Desensitization and Reprocessing) from respected colleagues, and became trained, even creating an innovation I called Bilateral Movement Therapy, combining EMDR with Dance Movement Therapy, which I presented at two International EMDR Conferences at Francine Shapiro’s request, the originator of EMDR. I found EMDR to be incredibly effective in actually healing the trauma that had been so stubbornly stuck in the negative beliefs, feelings and sensations that resulted from the traumatic experiences. I then became aware of another model for treating trauma called Internal Family Systems from respected colleagues and EMDR trainers as a way of deeply connecting with the actual Ego States, or Parts, that experienced the trauma in the first place. Just like our original family systems, we have an Internal Family of Parts that take on certain roles. The manager or protector parts are there to protect the exiles, usually younger parts that were traumatized. When manager parts can no longer contain the intense emotions, the Fire Fighters take over, and use alcohol, drugs, eating, and even suicidal ideation to put out those unbearable feelings. The concept of “Self” leads the parts with what is known as the Eight Cs — Calmness, Clarity, Compassion, Confidence, Courage, Curiosity, Creativity and Connection. Self welcomes all parts and hears and feels them in a way that allows the parts to unburden and heal. I now combine both models as a way of healing the trauma held in the body, the negative beliefs adopted because of the trauma and the intense emotions and sensations felt when thinking of the traumatic experiences.
Deb Withers has been doing both models — IFS and EMDR — for about 18 years. She is now about to embark on “Equilateral,” a method of using horses with EMDR, as well as Internal Family Systems.
