Dr. Sandy Newes Talks About Ketamine and Psychedelic-Assisted Psychotherapy

Chad Franzen 12:32

Yeah, I know trauma is one of your specialties. Is there anything else you wanted to to touch on regarding that?

Dr. Sandy Newes 12:39

Yeah, I think you know, one of the things that’s really interesting is when you read the ketamine literature in specific so, so, you know, MDMA has been launched as treatment for trauma. So it started off as kind of a, you know, event specific traumas, and, you know, first responder and veteran type traumas that are kind of more commonly experienced, and then has moved into developmental trauma. And the earlier literature in ketamine, again, specifically focused on ketamine treatment as opposed to ketamine assisted psychotherapy. They’re very different. Said that ketamine wasn’t good for trauma, and there’s still lots of people who hold that. And I do believe that if you just go to ketamine treatment and you don’t have the therapeutic support that it might not help, and it might it, I don’t know, it might make things worse. We occasionally see people who, you know, things emerged and they didn’t have any way to process it. They didn’t have any way to integrate it. They didn’t have, you know, therapeutic support to help them work through it. And so that makes sense, that people are struggling with that. But when you put in with a trained clinician who really works with trauma, who knows what they’re doing and who also knows how to work with ketamine, at that point, we have a really beautiful opportunity to do this work. So the medicine allows us access to content. It allows us access to memories. It allows us access, again, to the emotions and the physiological ways that that show up in a way that’s more direct and because the client is in that softer, less defended state. So for me, what I do very specifically is I follow really very similar protocols as I use when I work with clients in non medicine sessions. So I teach skills. I teach resource, which is the ability to access well being within the body, within the psyche, to be able to shift out of that traumatized state. So we talk about fight, flight, freeze mode, where our nervous system goes into that, and it distorts our perceptions, and we see the world through that, and we put that state onto the world. So that’s really the essence of a more neurobiologically based approach to working with trauma, and when we work with ketamine. So I do an extensive developmental history, and then I also, and then I. Establish treatment goals. And I also work, I teach skills, how to connect to the body, and I also teach some frameworks and some ways of understanding how state is really important, and it’s not just about content. So content is the what happened so and that is one thing when there’s been, like, a specific event, like maybe an accident or some kind of really traumatic event that somebody can identify that’s referred to as index event. But another big piece of working with trauma, particularly developmental trauma, which is early relational issues and struggles, where somebody unsafe in their world, is that it’s about state so this state of activation, that state of being in that fight, flight, freeze mode, and then the way going through life in that state impacts our perceptions of things. It impacts our reactions to things. It impacts our capacity to have relationships, interact with self, world and others. And so we’re really doing is working with that state and helping to shift that state providing skills and opportunities in order to do so with the medicine, to experience the shift in state, and then to help them apply that to the rest of their lives. So when I say shift in state, I don’t mean the actual like altered state of being, quote, unquote high. What I mean is the shift of state into being into more well being, into being able to be more emotionally connected, into being more emotionally connected to self or others, and then to be able to be in that state as we move through our lives outside of the medicine session. So it’s really not what people think. It’s not all about, like getting to the root and processing that moment it might be, but it’s really also about that overall shift in state?

Chad Franzen 16:43

So let’s, let’s say I, you know, having not experienced this before, I came into your clinic and was just interested in kind of a treatment process, the typical treatment process, what would that look like? Good.

Dr. Sandy Newes 16:54

So it looks like that you, you know, depends on if you contact if you’re coming in for cap, ketamine, cystic therapy, you might contact me or one of the other clinicians on our team, or the clinic first. So we work together, but we are kind of separate entities, and so the kind of critical pieces are you come into the clinic for an intake. So an intake means that you meet with our with our medical team, one or more of our medical team, sometimes for an hour or more, and that’s one of the things that’s not all the clinics do that. So we there’s the medical screen piece, and then there’s really taking of the history, and in the process, there’s a rapport building, developing a relationship. It’s of critical importance that if anybody goes to do ketamine work at a clinic, that they feel comfortable with the clinic, and they feel comfortable with the provider, because that that setting, that mindset, set and setting are important variables, that feeling of comfort in the setting, and the mindset that you go into, from a place of trust and feeling hopeful that this might help help and that you can really trust you can allow yourself to drop into the experience, is just critical. So that’s the medical side of it. And then on the therapeutic side, most providers do two to five preparation sessions in advance, sometimes more. My average is four. I generally do three to five. And so we’re going to do that before the medicine session, and then we’ll do the medicine session, and then we’ll do integration with 24 to 48 hours is ideal, really more than 72 and you begin to lose some of that. And in integration, I review the notes that I have with the client to prompt their memory, and we process the different elements of what came up in the session, and then my role is to ground that within the developmental history and hold the treatment goals that they’re working on, and trying to weave that all together so where the rubber meets the road again, is, how does this actually impact their life? How does this change their life? I personally do not prefer to only do one session. That’s really more if you’re doing more traditional psychotherapy and you want to have one session to try to deepen the process. The majority of what I do is series where I do three to six sessions with a client over the course of three to four weeks. That’s not always typical. Most people maybe do one to three, but it’s emerging more and more, because when we have those touch points where we go in, we have it, we do the integration and we go back in, it really allows those gains to deepen, and it allows the client to stay more in that shifted state, and to really stay more in that state of well being as they move through their life, and then that becomes their default mode, that becomes their more habitual state. I

Chad Franzen 19:43

think you kind of talked about this a little bit, but so let’s say, you know, all that sounds good, but I’m having not experienced it. Maybe I’m concerned about safety, or something like that. How do you kind of ensure that the safety of clients during these psychedelic sessions?

Dr. Sandy Newes 19:56

I mean, that’s a really great question, so, and it involves a. Lot of different levels. And so you know, the first one is medical safety. So if you go into any sort of clinic, depend, regardless of you know, how much sort of attention they pay to relationship with the with the patient, we like to think that you can count on the fact that you’re going to be held safe. So if it’s an IV clinic. Do they know how to put the IVs in, if it’s im do they know what they’re doing on that level? And then there’s different levels of monitoring of vital signs. So you know, at our clinic, they’ll take blood pressure before every session, they’re tracking again, they’ve done the medical history, so they’re understanding what your medical history is and what any of the concerns might be, untreated blood pressure is certainly of concern. High blood pressure, untreated high blood pressure, and they’re going to be watching that more carefully. Treated high blood pressure, that’s another story, but they’ll be taking your vitals. We have a little ring that we put on people’s finger, and we’re monitoring that and taking their vitals throughout. So we’re monitoring heart rate, oxygen saturation, and also then the medical provider is in and out consistently through the session. So I’m sitting with the client. I’m right next to them. We’re talking we’re processing throughout, but the medical person is also coming in. They’re checking the IV bag. They’re checking the drip rate. They’re making sure that that the patient is really just is physiologically safe. You know, they’re looking at them. They’re looking at their distress levels. And they’re also getting those impacts from from the patient monitoring devices that we use on this psychological side and the emotional side. As I said, I’m right there with the client. That’s also that’s kind of one of the misconceptions about psychedelic work is if we’re just kind of sitting quietly while the patient goes inward then, and the way that we do it, and we recommend, is that you’re involved with the client, so that the client really feels me in their bubble, like we are doing this. We are close together, we are connected and and I’m also just monitoring. I’m watching them, I’m with them, I’m talking with them, and I’m watching distress levels. Now, if there’s distress level, now we’re looking at, is this beneficial? Is this useful? Is this something that is part of their therapeutic process, or are they more in a state of panic, or even a state of dissociation, like, which is kind of another one of the misconceptions, like, ketamine is a, you know, is a dissociative anesthetic, but really, we’re looking at getting somebody right at the level where we’re having the benefits of the softening that that can bring, But that they’re not so out of it, that they’re difficult, that they can’t engage. So I’m tracking that, when is distress therapeutically useful? When can it be turned into a healing experience? Or when is it that somebody’s really more just in a state of panic? And that doesn’t happen that often, but if it does, you know, I use my skills, I use my techniques to help ground them. Help find that ground them in the present moment. I’ll have done some permission already about touch when I might put my put my hand on their arm to help ground them in the moment. And with IV, which is what we really like to use, is we can turn off the drip. We like we can turn off the IV, and they’ll begin to sober up in 10 plus minutes, we can slow the drip rate, so we can really slow the rate at which it’s coming on, so the patient actually has a lot of control. And then at our clinic, you know, our medical team is trained in emergency medicine, so our founder is an emergency medicine doctor, and so we have a we have all the different types of emergency equipment that one might need, although we’ve never needed it like really, just to kind of go back to the beginning, ketamine is actually extraordinarily safe, physiological, and the adverse effects that are reported with ketamine, primarily the people who end up in the ER and other places, are really psychological, And that comes, in our, my opinion, from a lack of attending to the client, the relationship the client’s therapeutic needs and the lack of the therapeutic process. One

Chad Franzen 24:11

thing you mentioned earlier was integration. Can you tell me a little bit more about kind of the role that plays in the overall treatment process? Yeah,

Dr. Sandy Newes 24:17

so integration, again, is an actual session where I schedule an hour that happens within, ideally, 24 to 48 hours after the session. So as I mentioned, I take notes throughout the session, and sometimes clients are like, really, what if I say something weird and that that’s not relevant? Like, it’s just, it’s my notes and my scribbled handwriting. It goes into their file, but it’s not something anybody else is going to ever see. But what it does there is it helps the client to also know that they don’t have to track it like they don’t have to sit there and try to remember about this important thing that came up. I’ve got it, so it’s really an important part of building that collaboration. And so. In integration, we go through, not necessarily word for word, what is said, but the themes that are emerging, right? That’s one of the skill sets of the therapist, and is to kind of make sense of those themes and to ground that in the in the client’s developmental history. So again, you know, this doesn’t just take place in a vacuum. It’s not just about the medicine, it’s about who the client is, what their developmental history is, what their relational history is, what symptoms they’re experiencing and how they show up for them, and then using the medicine as another window into that. So in integration, we go over the different themes that have emerged the client themselves begins to make sense of that. I bring my expertise in to kind of sort of start to weave together some of the background history and and then ultimately, you know, how is this relevant? How does this shift your sense of self? How does this help you see yourself differently? But then a really big piece of this that is emerging, and this is also something that isn’t commonly seen in the ketamine literature, is really helping clients deepen into their ability to just experience wellness. So I’m also looking for windows into moments when the client’s feeling differently, when they’re feeling better, when they’re feeling more supported, when they might be feeling lighter, they might be experiencing a sense of connectedness or love or oneness, super common in psychedelic experiences. And then we shift into kind of noticing, maybe where they feel that in their body, or what it’s like for them to feel that. And so in integration, I will also revisit some of those things, some of those things that came up for them, and help them deepen into not only their understanding of the difficult things or the hard things that they’re working with, but being able to really just deepen into a more of a felt sense of well being. So I’ll actually work with that in integration, a lot. So I might bring somebody back to kind of evoking a moment that was either really powerful for them or that was really meaningful for them, or a time when they felt really good in session. And then we really anchor that in the present moment, in the in the more ordinary state of consciousness, so that they can kind of carry that with them. So we’re also building bridges from the session itself into integration and then into daily life. So integration is a critical part of it, and it’s not just all like, Tell me what happened, or let’s make sense of what happened. It’s really it’s much more complex and sophisticated than that when you do that in a psychotherapeutic context,

Chad Franzen 27:41

okay, well, let’s, let’s change directions a little bit. Kind of, when we first started, you told us that living Medicine Institute is a training and resource hub for professionals. Tell me, I know that’s very important. Tell me a little bit more about that and what that

Dr. Sandy Newes 27:55

means. So living Medicine Institute was founded by Dr Sydney Goldman. She my business partner and I, she’s a psychiatrist. I’m a psychologist. We’re based in Asheville, and we initially started providing trainings for clinical and medical professionals who work in the psychedelic assisted psychotherapy space. Again, we use ketamine because that’s what’s legal. And so we have in person trainings. Those are done retreat style. And then we also have online training, so they’re virtual trainings online, and we emphasize a couple of different things in our training program. We believe that professionals having their own experience with the medicine is critical. So in our retreats, people do two medicine sessions back to back with different routes of administration. And in our level, one clinical intensive, which takes place online, clients actually do seven medicine sessions throughout so all four different routes of administration, and we do our didactic teaching at the retreat through a video series. So we have an we have a video series that Sydney created, actually, that really focuses on the nuts and bolts of the clinical application. So that’s kind of the second piece of our training. So we’ve got, you know, we really emphasize the experiential component, and then we also emphasize clinical application. At this point, what you won’t get in our training is a really conceptual overview of the field. We don’t really focus on all the different research and the biological mechanisms of the medicine. Instead, we really focus on clinical application and so. So in our retreats, people get the video series in advance, and then the whole emphasis is on experiential in our level one trainings, people also, we work from the video series. We talk about it, we deepen into the clinical applications and the how tos of how you do it, as well as then using your own experience with the medicine in order to really illuminate that process. We also do, especially in retreat, we do a lot of nature connection, bringing in the next. Natural World We really believe in, you know, the wisdom of ancient traditions and connecting to the natural world, grounding within the natural world is really, you know, is a is a way to do that. So, you know, human and nature really being interconnected, and the natural world is a living being with which we are in relationship with. So that’s a big piece of of what we do by just bringing that online and by bringing our awareness more to our environment. So we’re kind of grounding ourself in environment, which is another way to put that, and then that informs all of the different clinical applications, set and setting, the different types of interventions that we use, and ultimately how we work this is also very trauma informed so Sidney and I both work a great deal with trauma and trauma informed care really means not just focusing on processing trauma, but creating safety. So we really work on creating a safe, well held container, which again, is modeling for how to work with clients. So in our training, we really only take approximately 12 people to the retreats or the level one. So we build relationship. We build relationship with us and with each other. We attend to that, and then again, we use that to model set and setting. In level one, you get access to four different routes of administration. I am IV internazion and sublingual and in retreat, we do a group internasal experience, and you can do IV or im and work with the sitter. So what we think that is unique about what we’re doing is, again, that clinical application piece, that emphasis on the medicine, the appreciation of ancient wisdom and wisdom traditions. We don’t profess to be experts in that, nor do we profess to follow any particular type of kind of ceremonial lineage, but just an appreciation of the trans personal elements that naturally emerge for clients and us as we go through our own training is really, really important, and we’re really invested in building a community. We don’t believe that this work can be done alone. So we’re building a professional network. We have an online resource hub as well. With re with research, kind of all the trying to be as comprehensive as possible. With the research, we have a listing of events. We have a listing of other trainings that are available and relevant kind of news that is emerging within the space. So that’s called the psychedelic provider network. Currently, that’s going to be brought into the living Medicine Institute. And we’re really wanting to just provide resources for professionals at all levels. So medical level, medical, clinical, whether you’re just starting or want to commit to a more extensive training program, we want to provide resources as well. So we also have a YouTube channel that has a lot of different things on it, kind of a shorter term clinical applications, clinical snippets, different emerging things in the field, as well as interviews with other professionals. So we’re excited about it. And

Chad Franzen 32:55

yeah, okay, sounds great, and people can find out more about all those resources and that training at living Medicine institute.com. Hey, what? What do you see is, kind of, what do you see as kind of the the future of psychedelic assisted therapy and mental health treatment? Well,

Dr. Sandy Newes 33:10

that’s a really interesting question. So, and it’s really a changing landscape, kind of all the time, because there’s a lot of different forces at work here. First is not going away. So this, again, as I mentioned, I believe that it is a cultural change within mental health, and that there has been psychotherapy research, psychotherapy outcome type research that has been done in the field that is really well designed, it’s very well controlled, and it’s not going away. So it’s the first cultural revolution that’s been driven by science, and then it also kind of links back to those earlier research. So that’s something just really important for people to know, that there might be fluctuations in government and fluctuations and kind of culture and public perception, but that science is really at the foundation of what we’re doing. And so, you know, as I said, currently ketamine is legal. I think ketamine is the Wild West, so it’s completely unregulated. I mean, meaning a medical prescriber has to get a consult controlled substance license, but that’s it. They don’t need to have any additional training. Therapists who want to work in the space don’t need to have any training at all. Anybody can do it now. Again, the upside of that is it might be allow more access. Ketamine clinics are popping up all over the place. You know, this is like competition at its finest. People can offer it at lower price points. You know, what does that look like? But it can also look not awesome, right? So we see a lot of inconsistent outcomes. We have people come to us at our clinic from other clinics where they’re not getting good patient care, or where they had disturbing experiences. So in the ketamine space, what we’d like to see is that training be required, that clinics go through some kind of accreditation process or some kind of certification process, and so that patients coming in. And can be assured that at a very base level, the clinic and the providers that they’re working with, whether it be therapist or medical, have some basic assumed knowledge and some experience with patient care or supervision mentoring and a basic knowledge base. So that’s specific to the ketamine space. We’d like to see any of the at home use really be regulated. So we really stand for regulation, standards and ethics, like we want to see that in this field, and that really goes for the others as well. Right now, there’s a regulatory process going on. It’s both at the federal level and the state level. The FDA moved to not currently approve MDMA for therapeutic use, which is really disappointing to a lot of people in the space, because here again, the research is really compelling and just FYI, one of the things that’s important is that it was held to research methodology standards for drugs, not psychotherapy outcome research. So those are actually two different sort of methodological approaches to the research. So we think that’s still going to happen. It’s just going to be a minute so and what that’s going to look like is unclear in terms of what the FDA might require, but again, it’s not going away. Psilocybin is kind of moving through the state level, so it’s become legal for therapeutic use in Colorado, other states have bills on the table to allow for that. So clinics are opening up, and then here again, we want to be really clear that training, certification, some kind of supervision, mentorship and oversight, that there is a regulatory body to for grievance to be called or for ethical violations to be tracked so that a consumer, a customer, client, can feel trust in where they’re going. Then there’s other kind of you know, LSD also has recently been given experimental status where it’s work with for its work with generalized anxiety disorder. Five Meo DMT is kind of moving through as profound therapeutic effects, and Ibogaine for addiction. So we have lots of movement, lots of things, and then the final piece of this, really that’s so important is that, and it’s also really important to be discerning. So some of the media hype will lead clients to believe, and providers themselves to believe that it’s this one and done thing that you like, you know, that you go have a session, and everything is cured forever. And what is factually true is the more clinically complex the issues, the longer it’s going to take, and the more skill the provider is required. So just kind of knowing that going in. So, you know, we need to temper this excitement and this movement and this adoption of these kind of novel and emerging ways of working with mental health, with discernment, with science, with skill, with ethics, with standards, and so that data is actually really quite interesting and and I think it’s really important that those of us in the field really be tracking that stay involved with that, and really participate in in guiding that, so that people can so that ultimately We can maximize patient outcomes, because we need better mental health. We need a new approach to mental health in this country, because people are suffering and clients are ready for it, and that’s what they want.

Chad Franzen 38:33

Okay, sounds good. Hey, Sandy, it’s been great to talk to you today. Thank you so much for all of your time, all your insights, and for having me. I’ll hopefully talk to you again some about some of the time soon. Thank you so much. That

Dr. Sandy Newes 38:43

was great. Thank you so much, Chad, this was great. Appreciate it.

Chad Franzen 38:46

So long everybody.

Outro 38:49

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