How We Can Hurt: Psychedelic Psychotherapy and Harm

Dr. Signi Goldman 17:41

like, some of this you’re saying makes total sense from a clinical point of view. And I imagine that a lot of listeners would be like, yeah, I totally get it start low. Someone has had a scary experience. But I think it’s important to note that a lot of providers in the space don’t necessarily have that philosophy or encourage people to go low. Some do, because, as you need a lot of beliefs out there, yeah, and I think there’s, so there’s definitely some providers out there that would encourage people to just, you know, blast through their fear, or things like the things along those lines.

Derek Rinaldo 18:18

So, you know, I mean, especially since the 60s, when psychedelic use sort of became more culturally open from, you know, research that was done in the 50s and 60s, there’s really relatively it’s rare that people have adverse effects, actually, but people do, so that’s the thing. And so maybe most people will be okay, even if they have a hard time, you know, they’ll be okay. And it’s there’s some factors that help people get through those things, but people’s difficulties usually resolve.

Dr. Signi Goldman 19:00

Yeah, yeah, it’s interesting. I mean, I think the fact that actually most people are okay and even with challenging content is also valuable. Those are some of the tropes out there that we actually agree with, right? I actually do think challenging content can is very valuable. That’s not a bad trip. And most people actually do, well, um, that is the case, but that, because that is the case, I think that also leads to this under reporting of the the KAT, the people that don’t do well, they are the majority. But if you are stepping into this space and going to be a provider, and you don’t have skills, or you don’t have the ability to screen or track or watch for this. It’s going to happen, and you’re going to be responsible. And I think this is why you and I, we keep tooting this horn like and so we’ll talk a little later about maybe for our audiences, therapists or medical providers, clinicians. That are starting to do this work maybe a little bit later, about ways to mitigate against that, or get supervision. Or, you know, what do you what do you need to do to make sure that you’re not going in naive about it? Because what I see a lot is, yeah, your first 10 or 20 people will do great, maybe even your first 99 people will do great, exactly, exactly. So you get, you go, Oh, okay, this is, no, I got this. And then you run into someone where you really mishandle it and harm, harm is caused, yeah, and that one is, is, is too many. It’s so if you can be taught skills for that, then that,

Derek Rinaldo 20:41

and I’ve worked with a couple folks in town who have had experiences that with other providers who have, you know, have experience in whatever tradition they they are, yeah, and then, but Then they’re left with, like, I’m the one person that this person didn’t handle properly, you know, they’re left with, you know, this like persistent hallucination problems, You know, or actually triggering some latent schizophrenia I’ve had someone who fell into some psychosis afterwards and had to be hospitalized. I’ve had people with increased suicidal ideations and from people in town,

Dr. Signi Goldman 21:36

yeah, and when you say people in town, you mean people with reputations for knowing what they’re doing, yeah, and it’s sort of a reinforcing that this is just their you know, I know I’m almost saying this over and over again, but maybe that’s what needs to be be heard, is that no matter how trained you are and no matter how comfortable you are with these medicines, some people get hurt by them. And so what are you then going to do? How are you going to screen for that, which is what you’ve spoken to already, and then, you know, how are you going to do something different for preparation and integration? But also, how are you going to get those people resources and and stay with them. The fact that they’re coming to you Derek is emblematic, to me, that the original provider isn’t really staying with them through this, this process, this process is harm. And exactly

Derek Rinaldo 22:31

what’s happened with with probably four or five of my cases is that, well, we’re we did the thing and we did, we did a couple integration sessions, and now we’re done, right, that this person that you know a month later is having panic attacks, or, you know, feeling suicidal. So

Dr. Signi Goldman 22:50

that is, that’s, I think that’s extremely important. Yeah, I think they’re one of the biggest problems in education in the space right now is a lack of emphasis on integration as an ongoing thing. Like, in my in our training, we have a curriculum unit on this where, like, the kind of catchphrase is, like, you know, because there’s a lot of question, how many integration sessions do you do? Three? Do you do five? Do you? And we have this, you do it until you’re done. Like you do you stay with the client until there’s no residual symptoms, and there’s no residual with concerns, and that might for some people be a long time. It’s not for most, yeah, but for some it is, and especially if they’re coming up with a lot of challenging content, then that really is your responsibility. Yeah? So I mean, maybe one of the biggest messages you and I need to get out there is, is follow up with your people and continue the integration process. And if you need to bring in medical or other providers, have a network for that, yeah, you know, the psychiatrists or, you know, have a resource network for that, because it is actually your responsibility. You are the person who has given them, you know, the medicine and taking them through this challenging thing. And if something is cracked open in them, or some symptoms have been triggered that they’re not safe and not okay. Yeah, I think that’s where the the lack of ethics can come in. But I I agree with you with this where you said it’s like unconscious incompetence, but people are not trained to know what to do with that, so they just kind of say, oh, sorry. That doesn’t usually happen. Don’t know what to do. Is that? I mean, I’m, I

Derek Rinaldo 24:29

don’t know what to do. And then people, I think people are kind of left like, oh, oh, shit. I don’t know what to do now with this. You know, even if they like, Okay, we did our three integration sessions, and you’re off on your own, and the person calls back, and then the person’s like, oh, okay, I don’t know what to do now. Yeah,

Dr. Signi Goldman 24:49

I don’t have a tool set for this.

Derek Rinaldo 24:51

How to handle this, yeah?

Dr. Signi Goldman 24:52

So yeah, it strikes me as is a double, double harm in a way. Because there’s the symptom that the person is actually struggling with, which could be quite dangerous or concerning. You mentioned increased suicidality or psychosis. I mean, you know, this is, these are very serious, like safety pieces. But there’s also, I would imagine this real, like relational betrayal. Maybe you put this trust in this person to take you through this very vulnerable thing,

Derek Rinaldo 25:21

which can be, you know, like, we’re really vulnerable in a a deeper way. And, you know, childhood stuff can come up, and hopefully it does, but hopefully it’s resolved. But if it’s not, and something like, you know, childhood abandonment issues or trust and stuff that can really service and stay and stick? Yeah,

Dr. Signi Goldman 25:42

I can imagine just a lot of like attachment, wounding and just psychological harm, in addition to psychiatric or other types of emergencies coming up, yeah? Just, you know, just to reiterate, doing this work is relationally very intense, right? So there’s Yes,

Derek Rinaldo 26:01

I might do a two hour ketamine session with somebody, and that’s that could be tiring, you know, on our end. Yeah, so,

Dr. Signi Goldman 26:15

so you’re seeing, I think some of the things I’m seeing and but I think you are working with a little bit more of these people, proportionally to your practice, than maybe some of us are. Do you Why do you think that is, do you think people have just, you know, heard that you’re someone who understands this? I

Derek Rinaldo 26:34

think it’s just word of mouth that it’s come come through to me. I don’t even have anything like this on my website. You know, I am on, like, the maps, Lycos integration website, and I’ve gotten several people, you know, that have come to me through that.

Dr. Signi Goldman 26:49

Because I imagine you didn’t start out thinking I’m going to have a practice with working with people who are harmed by psychedelics. No,

Derek Rinaldo 26:56

no, I didn’t. Yeah. So I think it’s, I mean, I know some of it is word of mouth, at least, yeah. And I think, you know, on my website, it talks about that I do ketamine assist, ketamine assisted psychotherapy. And I think some people just like, Oh, this guy, well, maybe he knows about this stuff too.

Dr. Signi Goldman 27:16

Yeah, yes. And to be clear, where you know, both of us are, are ketamine providers, but we also will often get clients coming into our practices who have had experiences with other psychedelics and other kinds of things. And so when you know this conversation is sort of speaking to psychedelics globally. Well, I have certain folks come

Derek Rinaldo 27:36

to me because, actually, more of my folks come probably because they just something happened at a festival, you know. And they’ve actually had, like, pretty significant psychedelic use, and then they were at a festival once, and two months later, they’re still having panic attacks, you know. So that’s where a lot of my people come from, yeah, as well as people who have gone to other, you know, providers and experience persistent problems afterwards that weren’t resolved or integrated. So,

Dr. Signi Goldman 28:11

yeah. So there’s, again, there’s some categories. There’s sort of supervised non clinical use, and then there’s supervised use by providers that just get a little bit in over their head, maybe you can say that, yeah, yep, yep, yeah. We, you know, we run a very medically monitored clinical type of psychedelic work using ketamine, and we have, I mean, almost none of these kinds of outcomes. And, yeah, it’s almost a little bit of a sounds like a little artificial thing to say, like, oh, we never see these bad outcomes. But I really think it’s that it’s a monitored clinical setting, but there’s a lot of preparation and of integration, and there’s no, you know, the integration can go on for a very long time with and then therapists are skilled to work with that content

Derek Rinaldo 28:57

and a lot of and there’s a lot of, like, direct attention and care, you know, to that person in a controlled setting, right? As opposed to being at a festival or a party or running out from running around out in the woods with friends, you might not get that kind of attention on you. And you know, if, if psychedelics can really poke unknown suffering that’s held in your pain body, you know? And so if a festival and something comes up, you’re probably but that’s not the context for it, and so you’re probably going to push it down and suppress it, right? Yes. Oh, right. And then just go on dancing or whatever. And then afterwards that that surfaced a bit, that bubbled up,

Dr. Signi Goldman 29:48

yeah, and then you feel, you just feel unsettled or raw or symptomatic. You don’t even know for sure why, because you don’t have a story to attach to it. But something,

Derek Rinaldo 29:57

something came up. And. I it wasn’t the right time or place, so I pushed it away, but it was big. And now, you know, after this party or festival, I’m a wreck, yeah, so, yeah. So

Dr. Signi Goldman 30:12

there’s a couple teaching points in here. One is one that I think a lot of trainees have heard a lot, which is set and setting, you know, the idea of, like, you know, really being conscientious about set and setting, which in in this context, is a clinical setting with what you named, with a therapist really sitting with you and tracking your experience along with you the whole time. So it’s helped therapeutically while you’re in the journey. Yeah, and then there’s preparation before integration, after which we can we can break down a little more. And these are really the building blocks of, basically, how to do this work well. And unsurprisingly, these are also the places where, when things go badly, things these steps, have been neglected. Yeah, yeah. I do want to circle back really briefly to one of the things you name, which is fear. Because I think some people have a question about, like, if I’m afraid or nervous. Does that mean that I’m going to have a bad experience? Yeah. You know, you named bad trips as something that you kind of screen for when you’re when you’re doing this work with people, yeah, and I guess I would say a lot of people come into our clinic nervous or having had prior negative experiences, we spoke a little bit to working with that. But I think there’s a difference between working with your fear in a sort of therapeutic way, where you feel that the set and setting is controlled and that you have agency, and that your therapist is like literally tracking that with you and talking to you about it, or being thrown into a place of like terror, and just being out of, you know, completely disoriented or out of control. And there’s probably a lot in there. There’s also people’s, you know, trauma histories are relevant. So really, what I’m saying is, I don’t want the listener to take away the impression that someone having being afraid of the experience means they can’t do it, but it certainly means that you need to do like, a lot of work up front with them, yeah, collaboratively, and make sure they are tracking themselves really authentically, and that they are actually really feeling ready to step into this in small ways. And you’re not kind of saying, oh, let’s push you back under and see what happens,

Derek Rinaldo 32:24

right? And so I think this is why it’s important to really establish a strong therapeutic relationship. That takes some time, perhaps, if a person has has a lot of anxiety going into it. And you know, I think there’s particular things to really get into in preparation. I actually have a preparation workbook that I give to folks if they’re going to go do it, do a thing somewhere, or when I use ketamine with folks that. And you know, there could be a preparation I even have a preparation checklist that, you know, involves just personal, personal history, education history, you know, your trauma history. What are your fears? Let’s get into this stuff. Yeah. So, yes.

Dr. Signi Goldman 33:11

So, yeah, I could really go. It’s so tempting to want to go into a whole conversation around, like, all the things that should be in preparation, because I think we have that in common. But I’ll just summarize that for this particular purpose by saying, know how to do preparation really well. We have modules on that, but having a checklist or having a thorough understanding of what’s involved, get a go. I’m just speaking to the audience here. Get a training program that really teaches you that really well. And we’ll leave it there, but we’ll kind of just highlight the importance of it. And I

Derek Rinaldo 33:44

like what you said about just fear and anxiety being useful, you know, for allowing us acceptance of these fearful and anxious feelings to be a part of who we are, you know. And I think internal family systems actually really works well with psychedelic kind of therapy work. So I think that the fear and anxiety can be really useful until it’s overwhelming. Yes, yeah.

Dr. Signi Goldman 34:18

And for those who don’t know what that is, that’s referring to parts work, or the idea that, you know, we have parts that are afraid, or parts that are are very protective and don’t want us to let go of control. For example, you know, aspect of ourselves that need to, you know, have various ways of feeling safe in the experience. And one of the ways I see a lot is losing control is unsafe, right? There’s a lot of ways that look but that, yeah, I agree with you that the important that those can be super valuable things to work with, actually therapeutically. So there, the fact that you know your client has some fear, is okay, yeah. Steamroll over there. Paja. Trip artist, where

Derek Rinaldo 35:00

the juice is, right? That’s where the juice is, yeah.

Dr. Signi Goldman 35:05

So I wanted to make that distinction between a bad trip and sort of the fact that someone has is nervous or afraid the second, the latter can be completely therapeutically valuable to work with. So I’m curious, if you’ve seen this is the this, I think, falls under harm, but it’s a more subtle thing, and that is, like, I have seen a tendency in some clients, which, I guess is the phrase spiritual bypass is often used, but the idea that, like, they’re really using the psychedelic experience for kind of escapism from distress and recur going back to it and kind of relying on it and and that being counter therapeutic, but the provider not picking up on that and almost accidentally aligning with it, like, Yeah, we’re gonna get you into this mystical place. And that’s like, now we’ve done you some good. Yes, yes. Thoughts about that, because I

Derek Rinaldo 36:04

think I said this earlier. I call them bliss chasers, yeah, yeah. Maybe they’ve heard about the mystical experience, and that’s where the the real, you know, beneficial results and outcomes are. Or I’ve had this experience a long time ago, and I just want that again and and I think that that there is a bypass, because if you’re chasing that, or you want that, then you’re not here, you’re still there. You know that. And I think that we people’s, you know, our anxieties, our fears, our insecurities, or whatever’s holding us back on this plane of our personality and psychology, like, that’s where we need to really do the work, not getting out of that. Like you say, We’re bypassing all that stuff, you know, right?

Dr. Signi Goldman 36:54

So if you’re if you’re a therapist, what this can look like is like the person will say things like, I feel healed when I’m there, like in the psychedelic state itself, becoming healed now, and when I come back, like my problems come back. So I just want to go back to that healed place, right? And yeah, it can be easy for an untrained or an unexperienced provider to be like, Yeah, let’s put you back in that healed space some more, and just kind of actually align with that. And, yeah, I agree with you, really, what they need to do is take some insight or some awareness or some shift out of that that then moves into their actual everyday.

Derek Rinaldo 37:33

Yeah, this is where integration comes in afterwards, right? Like, how do we taste, take this experience and and really make, you know, meaning of it that we can generalize into our life, not just this really cool, amazing, spiritual thing we did once, and I want to do it again, you know, and get there, otherwise we’re stuck there.

Dr. Signi Goldman 37:56

So what are those? Some of the ways you see that integration go badly,

Derek Rinaldo 38:02

well, too short, yeah, I think where it’s just like a sharing circle, which can be really helpful to go to. You know, in Asheville there’s a psychedelic meetup groups, you know, like those can be helpful, but I think people can be not heard or dismissed and there’s groups or not really get their point across, or feel really anxious when they’re in a group, and not be able to tell their story or find meaning, and there’s not enough attention in group settings. So, and I guess if you know you’re with a therapist, or just someone who you who you trust, and you care about, and you’re trying to talk to that they’re not really attuning to your experience. That’s why I think a therapist can be really helpful, because we’re trained to do that, you know, yeah, or somebody just doesn’t even do any kind of integration, and they just kind of carry on and go to work the next day.

Dr. Signi Goldman 39:06

I’ve seen that a lot, yeah, not, and I see that a lot in people coming from underground settings, but more than you expect, also from other clinical settings. Yeah. I think there

Derek Rinaldo 39:19

can be, you know, like psychological, kind of old trauma can come up and be unresolved through during integration, even, right? And you know this, the inability to make meaningful changes, behavioral changes, I really think that, like we’re more psychologically flexible after a non ordinary State experience and neuro plastic, you know, and and I think making that stick with behavioral changes, which is going to take some persistence and discipline and choice. And I think that

Dr. Signi Goldman 40:02

that really needs a one on one relationship, like you’re not going to get that kind of coaching or mentoring or nudging in a group sharing circle,

Derek Rinaldo 40:12

sure, and some people you know might, I mean, I think it required, like I said, it requires discipline and at least self accountability to implement some behavioral changes otherwise, maybe psychologically, and we have this big emotional, even spiritual experience, and then it sort of fades if we don’t anchor it with behaviors over time.

Dr. Signi Goldman 40:37

Yeah, there’s this interesting connection there between the integration and the preparation stage to go back, because I think people’s expectations aren’t framed always wisely, like I see people who they’ve gone into an experience, and they’ve sort of, it’s sort of been implied, if not outright said, that this is going to heal them or fix them, right? And the provider doesn’t say you’re actually gonna have to do some work like this is gonna take some work here. We’re not just gonna wave this pixie dust over you today, and then you’re gonna be a train, a changed person. And because the that kind of one and done pixie dust experience does occasionally happen. It really does over represented in the media and in this public discourse. And so I think a lot of providers don’t do the work up front to say, hey, we’re going to do these journeys, and then we’re going to do a bunch of work around it after Right, right, right. And integration is going to be work. It’s not always going to feel good either. Integration is,

Derek Rinaldo 41:38

you know, just as important, maybe, if not more important, than the actual experience itself, you know, and I think that you know another problem that can occur post experience, during integration, whether you somebody, whether you with an integration provider or not, there can be this, this sort of like psychological dependence on on a medicine or a person you know, to keep providing, like, I think you can, we can get stuck in it and, like I said, like chasing it to fix me, yeah, yeah,

Dr. Signi Goldman 42:15

yeah. You just touched on something there, which is another form of harm, I think that can happen, which is this over attachment to the provider, yeah, this is particularly vulnerable in underground settings where boundaries can be less carefully held, right, um, where there’s almost, like a little bit of a guru phenomenon, right? Like, yeah. And I that could that obviously, psychologically, really can be in lots of subtle ways, damaging for someone and and also under recognized by both parties. If you are, you know, a lot of this is another place where the providers, often aren’t, aren’t aware that that’s the kind of harm. Yeah, the

Derek Rinaldo 42:59

cptr program like there was a whole lecture, maybe two lectures, about spiritual narcissism and psychedelic narcissism. There’s a lot of attention was paid to that. So,

Dr. Signi Goldman 43:14

yeah, I mean, I’ll say this to our listeners. You know, you have to track yourself as a provider, because people are having incredibly potent experiences that maybe something more potent than they’ve experienced in their life, or certain, or certainly different than anything they’ve experienced in their life, very emotional, very intense, and they can project that onto you as the therapist in ways that sometimes overtly, but oftentimes it’s in subtle ways that you If you’re not tracking for it, you can slide into a dependency on you, or a sort of reverential energy that the client will have towards you, and that is that’s not a healthy boundary for them, and it’s also a particularly sticky psychological territory. So I mean, these are important to talk about, because these are some of the more subtle things that I think aren’t often overtly talked about. Enough in trainings, I had

Derek Rinaldo 44:05

a client who really holds some belief in past life regression and these kinds of things, and he had an experience that the provider and he had many past lives together, including being lovers. Oh gosh. So kind of oriented to that provider in that way, wanted to, wanted to persist with a relationship, you know. And thankfully that provider was like, oh, like, held it really well. It was like, this is yours. This is where you’re at, and didn’t just reinforce it or validate it, you know, from where that person was at. So

Dr. Signi Goldman 44:51

very interesting. That’s, that’s really interesting. And I think that, you know, some of the more well known, or the more well known incidents were the maps trials of like. Trials had damage that was not the exact same situation, but that kind of blurring of boundaries, which goes without saying, you know, it goes against all of our therapeutic ethics, but those that can get blurrier with when you have psychedelics involved, for the client especially, and so it’s our job to be especially vigilant on those those fronts, yeah, yeah. That’s a, that’s a an interesting one that I have definitely seen, and a more subtle one, thoughts on things that can go wrong during the actual the session itself, the Administering of a medicine, or the way that the therapist engages with the client on the medicine, have you seen

Derek Rinaldo 45:44

how well I think that you know they’re complete we might call like psychological fragmentation. You know where you know deeper, hell, pain, sufferings, traumas, wounds can be on Earth excavated, and people can really blend with that. And that can be very useful, but has to be handled very adeptly by the therapist or to be able to work with that so seeing that that happen,

Dr. Signi Goldman 46:24

so it’s really almost an argument for having a really good therapy skills, like almost, you know, this is something I feel like I say a lot. There’s a there’s a there’s a lot of people doing this work who have what I would call sitter skills. This comes from underground where, like, I’m really comfortable being with you while you’re on this journey, but that’s not the same as knowing how to do trauma work with someone if their trauma is coming up, yes. And so my personal bias is like having a strong psychotherapy background and knowing how to do trauma work, often, ideally, even somatic interventions if needed. And because, yes, I imagine it’s, you know, my experience has been and I’m curious if you’re so similar that people will have really hard things come up in a journey, often complex trauma pictures and things like that. And the sitter will just sort of sit there with them, yeah, and then it’ll be done, and the sitter will make sure they’re sort of oriented, and then chat with them about it. They’ll sort of and then go right. But the trauma content is not worked with it’s just stirred up, exactly, but sometimes, and then the person is really dysregulated and scared, yes,

Derek Rinaldo 47:49

yeah. And I think it does take some intervention. You know, it’s like sitting is sitting, facilitating or guiding. That’s something. But you know, therapeutic interventions when difficult material is really blended up, you know, risky, really risky behaviors can ensue. Or at least, you know, the panic can happen, and then this can persist, if it’s not not handled well by someone with some real therapeutic interventions. You know, sometimes in I teach people breath work practices, just in my own practice anyways, but if someone tells me that they had a difficult psychedelic experience, or they’re planning to have some experience down the road, I almost always teach them some breath work skills, you know, and some somatic posture work,

Dr. Signi Goldman 48:50

yeah, that I think that that would be extremely valuable, and because I want to speak to an audience that may not have breath work skills, I will say My thought on this is that’s actually an amazing thing to study if you have the resources and ability to do it. Those of you who are stepping into this profession, if you don’t, I think the broader message behind what I hear you saying, Derek, is have some way of helping the person use skills to regulate. Yeah, whether it’s, you know, some people use mindfulness queuing or other kinds of somatic touch, obviously you would collaboratively work that out. Sure, breath, but breath work can be an amazing way to do that. So I think let’s some of my take homes that I would like the listener to to take out of this conversation if I had to kind of crystallize, really, I think my interest in interviewing you Derek is really to get the word out for new providers, like, think about this. Don’t just go out and be like, I have no plan if something goes bad. I guess, okay, I’m kind of stuck, because that’s happening a lot. One of the first take homes that I’ve that I’ve heard you say, is have a referral network if you actually have a psychiatric outcome that’s damaging, like, if someone does develop psychotic symptoms or gets, you know, stuck in a in a manic situation, or becomes more suicidal, is you maybe, if you’re going to go into, like, psychedelic psychotherapy, have a established referral network for that, like, know, where you will send someone in your network. And that may not be easy to find, but it is whole, you know, you have to do that, not something to mess around with, because then people are just getting stranded, like you named and

Derek Rinaldo 50:36

and it’s not only, I think. It’s not only like new providers, but I think people who have been practicing for a while in whatever mode or tradition they do to really like be have get some peer support and peer discussions going on with people who know about this and really actually be checking your own consciousness around your skill and experience and check yourself before you go into something. It’s not just like, okay, so and so is coming over, and we’re going to do this thing for some hours today. I think there’s like the practitioner needs to prepare. You know,

Dr. Signi Goldman 51:16

yes, there’s an over casualness that see, like, that’s a big deal. Like, well,

Derek Rinaldo 51:25

when I’m gonna go do, when I’m gonna do a ketamine session? Yeah, wow. I make sure, like, that morning I’m settled, I’m in myself. Because if I’ve got some of my stuff coming up, or parts of me that want to be a really good ketamine provider, I’ve got that part really up. I’m probably, I’m not going to be relaxed and open to what’s going on with my patient, you know. So I think there really needs to be a lot of emphasis for the provider taking care of themselves in that way.

Dr. Signi Goldman 51:57

So I’m hearing a couple of things. One, I said, referral networks for if you do have, like, a you know, concerning outcome, whether that need to be medical or psychiatric or and then peer support for kind of ongoing supervision you tracking yourself as a provider, that you’re not stepping in over your head, and that you have someone to talk to about tricky dynamics or concerning dynamics and things like that, or maybe get support. There’s also, you know, don’t go into this work if your main skill is being a sitter, and make sure that you actually have a psychotherapy background to work with trauma content or other kinds of challenging content that comes up, otherwise you may stir something up for your client that you’re not equipped to then to then address.

Derek Rinaldo 52:49

I had a couple ketamine sessions scheduled for late, mid, late October, and the hurricane hit and and and I was not ready. I was not in a good I wasn’t in the right space I wanted to be in to go do that, so I canceled it. Yes,

Dr. Signi Goldman 53:09

reminder, we were in Asheville, North Carolina. Both of us were that was and, but you’re speaking to regulating yourself and taking responsibility for going in fully in the right space, so that you can fully attend ethically to your client, right? So some other take home points, and some of these are big asks. So some of you who are out there getting into this work, we’re saying, have a referral network, have a peer support network and supervision, get maybe better skills, therapy, actual therapy skills, that’s a big ask that may involve the training. Have some tools for helping people regulate, like you. Derek of name, breath work, but working with fear states and things like that that also falls under therapy skills. Yeah, you know. And so this may involve getting more training, but if these are sort of a checklist of things that maybe don’t go into practice, unless you’ve really put some thought, and you can almost say, Okay, I have this and I have this and I have this, yeah, thoughts on where to get supervision. Is that something that you do, or that you point people towards, or I’ve worked

Derek Rinaldo 54:23

with a few so on, leaving the cptr program and the vast network of people that I connected with, I’ve got a couple colleagues that I work with, Not supervision, but perhaps mentoring in a way, you know? And yeah, and I work with some other therapists in Barbados in Trinidad and doing ketamine work. And so I’m sort of supervising, supervising mentoring training so other therapists there as well. So. But where to where to find that? I think it’s just, gosh, maybe the maps Lycos website might have integration therapists just to have a network. Yeah, yes. And

Dr. Signi Goldman 55:17

supervision is LMI has supervision available. Some of our providers do that for new career, psychedelic psychotherapists, and someone like yourself sounds like a resource. And so it’s, it’s beholden on you guys, you listeners, to go find these things. And it’s not, it’s not always easy. It takes resources, and this is where I say a lot to our trainee cohorts, like, being a psychedelic psychotherapist is a huge responsibility because of this vulnerability that people have in our capacity to do harm. And so I think that what I see a lot is people taking the easier road, because they because it’s expensive, or you may need to go back and get more training, and just kind of assuming that they’ll be okay with and getting and then you, you’re gonna, it’s, it’s definitely both Derek and I have witnessed these cases where things can go badly. So it may be that more training is involved, or you doing the internet search involved to get a supervisor for yourself. A supervisor does this work, and, you know, a peer support

Derek Rinaldo 56:32

network, yeah. And I think in some ways, like for providers doing their own work, and if they have access to ketamine, for example, you know, have those experiences safely with a provider breath work to have, you know, a non ordinary state. Experiences on their own can be really helpful to know the terrain, so to speak, of person that you may work with who is having difficulty.

Dr. Signi Goldman 57:09

Well, I think those are some really valuable take home points. If people want to reach you, I’ll just say your website is clearlifenc.com but North Carolina is N c, so c, L, E, A, R, L, I, F, E, N, c.com, correct, and your email is Derek@Clearlifenc.com, that information will also be on the the link below the episode, so people want to reach out to you that way, any last minute thoughts or advice or anything that you would like to put out there before we close for today.

Derek Rinaldo 57:45

Well, you know, like, these are powerful substances, and ketamine is at the forefront and legal. And thankfully we have that. And as let’s go on wherever this goes in a post approval world. They’re powerful substances that need to be handled really carefully. So much healing and joy and expansion can happen for people, and people can be harmed as well. So I think there needs to be a lot of care. And these substances, you know, other substances, have been used for 1000s of years, and with care, we can, oh, that’s the thing with Yeah. So,

Dr. Signi Goldman 58:35

yeah, yeah, thank you. I agree. Maybe our biggest sort of message collectively today is people want to put this in a box, like psychedelic work is either good or it’s bad and dangerous, and have a hard time in our modern Western world with with the nuance of both and powerful and it can be power, it can be heal and It can harm. Yeah. So we have a responsibility to name that and to show up for that in the most ethical way we can so. So thank you very much for being on. Really appreciate it.

Derek Rinaldo 59:13

Yeah, great. Thanks.

Outro 59:16

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