Ketamine-Assisted Psychotherapy for Trauma: Some Healthy Debates

Dr. Sandy Newes 25:31

Thank you. So Amy you ask kind of a follow up? Do you want to speak to that?

Amy Nicholson 25:37

Sure? This is Amy from Madison Scottson. So I guess I’m just curious in terms of what Barbara was saying. You know, she noticed the dysregulation in between. And so my question is, would that be a good time to just do more integration than before doing a second dose like with someone who we might predict to kind of unravel how much more preparation and how much more integration might we do? Like, could we just slow it down and really titrate it, you know, and take several sessions to prepare, several sessions to integrate in between, you know, or is it sometimes better to go right into the medicine? 

Dr. Signi Goldman 26:26

I’m going to go first on this one and then see what Sandy thinks, because it’s kind of interesting. It’s, it’s a little bit how you frame whether getting dysregulated is a problem or not sure we think it’s so obviously we don’t want to cause distress, and we certainly don’t want to re traumatize, and we don’t, you know that all that goes without saying. So some clients are more willing to have those experiences than others. I’ve noticed, like for some clients, we say, Okay, this might be part of it, and they have a willingness, and others don’t have a willingness. So there’s almost like a willingness variable. And the thing you said about, can you just take more preparation time, and all that is is it is a answer. I think that’s what a lot of people do. They slow down. They take more preparation, preparation time and more integration time before the next session, especially if the person’s fear is of the medicine. And I guess I want to hear what Sandy actually does in that kind of a context. But I would, I often am having a conversation with the client about their willingness to do it again, if knowing that that might be the experience. And then we are doing like realistically, we’re usually lowering the dose. And then we’re tracking, I’m tracking along with them, watching to see if the experience comes back, like in a collaborative way, if that makes sense. And then we have had a conversation that if that happens, where we may need to stay with it, or are they willing to stay with it? If I’m, if, God, I’m going along with them. So that that way of framing it is, you’re not really trying to avoid a dysregulated experience that much, but there are matters of degrees here. I mean, are you talking about complete panic or something like that, that would be totally different, or are you talking about they’re very afraid of what they’re experiencing?

Dr. Sandy Newes 28:17

Yeah, I would say those things would be different. Yeah.

Amy Nicholson 28:19

It seems to me you’re right, like I met, I have a new client that I was meeting with today, and it’s the first time she’s ever done therapy, ever, and just within one week, she started to unravel a little bit, you know, which is normal when you start to enter into a relationship like this, where you actually start to feel your feelings and notice your patterns and look at yourself. So it makes sense to me that people would feel a little unraveled and dysregulated, or whatever you want to call it, right? So it also seems like it would be a really great skill to learn how to be with yourself in those different states, rather than avoid, right in some ways, and I don’t want to use the word avoid, but you were mentioning that before, in terms of tying that back into like resource and regulating can become like avoidance. So I know it’s a little off topic, but kind of ties into what you were talking about before. And I just think it’s really interesting, because I think building capacities,

Dr. Signi Goldman 29:21

yes, it is really interesting because you don’t want, yes, none of us want our clients to suffer. And also the presence of a dysphoric feeling in between sessions, especially if it’s a new one, is often kind of valuable content, actually. Now you you may not be a know what that is during the in between session stage, like when you’re doing integration and preparation for your next one, you may not know why they’re dysregulated. I mean, this is true for trauma work in general, of course, like someone can be dysregulated doing trauma work, but a lot of times they’ll be saying, I am feeling such and such a thing. I’m. You know, and when you go in the second session, then you can explore what that thing is or what that feeling is, and find out if there’s content behind it. And I can go into more detail if you want, but so I don’t necessarily see it as a problem. I have compassion for the client situation, and I don’t want it to keep lasting, but I guess I’m just repeating what you’re saying is that maybe it’s often part of the process of trauma work period,

Dr. Sandy Newes 30:27

but also a big assessment piece. Sorry, I didn’t where you want to say. I was

Dr. Signi Goldman 30:33

just gonna say I wouldn’t let anyone leave my office in a really dysregulated state like so I’m talking about matters of degree here. I

Dr. Sandy Newes 30:42

mean, I think that it’s also a huge assessment piece, that there is a really important piece in preparation of of assessing somebody’s relational capacity, their capacity for emotional intensity, their capacity to resource, their capacity for self regulation. How much trust do they have in you, in the practitioner? So I think that’s and are you always going to get it right? Absolutely not. But you know, if your assessment is that they’re going to be more fragile and they are more prone to that fear response, or they are more prone to panic, then you’re going to want to just tell them, we’re going to want to do more preparation. And there’s where that piece around the parallel process comes in. Like, are they afraid of the medicine? Are they afraid of the content, or are they afraid of intensity? Are they afraid of you? Are they afraid of being vulnerable? Like, what are they afraid of? Because I think that. And again, are you always going to get that right? No, but that’s also going to inform what to do next, like, if they’re afraid to be vulnerable in front of me, and that’s really where the panic, then I’m going to be wondering, how else does that play itself out in their life? And then it’s going to be a heavy, relationally oriented time, and I’m not going to back out of that. You know, if they’re afraid of the emerging content, then we might want to slow that down. But you gotta like also, I also have a lot of faith in somebody’s capacity. And here again, that’s where you know my belief about the importance of building in these skill sets and them understanding a trauma response and understanding self regulation in the brain, the nervous system, and how that works prior to going in is so important because then you’re not trying to teach them when they’re under the influence of the medicine. And I always, if somebody does get really dysregulated during the time, I just assure them, like, I’m not going to let you stay in this. Like, I promise that we are. I will not let you stay in this. And then do you you know, shall we go deeper or should we back out? Give them a choice? Do we want to keep going, or do we not? I will not leave you. I will not let you stay in this I got you. That’s when it’s really important to communicate through your voice, through your energy, through getting in close, like I got you. And when somebody has that level of trust, like, let’s just put content over here. Like that, in and of itself, is a huge piece of trauma work. So always really holding that relational lens and that relational capacity, and then that would also inform how quickly we want to do it again. Like, I really believe in expansion and contraction, like, I really believe in the power of the medicine to help maintain expansion, softness, a lightness of spirit, the ability to calm the dysregulation. So do we want more time between the medicine? I don’t know. That’s more time for for contraction, right? That’s more time of like returning back to like, normalcy. Is that, is that our goal? Do we want? That That depends on how incapacitated they are. Like, I think in terms of the three Ds, duration, distress, dysfunction, are they, how are they doing? Like, are they unhappy, or are they not functional? You know? And so really, it’s a, really an ongoing assessment. And like, what Sidney said, I mean, you know, being dysregulated and being upset in, you know, like, you don’t want to send somebody home that way, but do we also really want them to be perfectly buttoned up either, like, that kind of depends on where they are, like, and that’s where doing more than one session is, I think, is of critical importance for complex trauma, because then you have the opportunity to kind of go in again, and it becomes a sequence and a process, not just like a one and done kind of thing.

Dr. Signi Goldman 34:32

And I’ll say, for the sake of the audience, this may go without saying, but we’re talking about the fact that some dysregulation during the CAP process, even in between sessions may be okay and is content, and you work with it and everything Sandy has just said that is not the same as sending someone out at the end of your entire treatment still dysregulated. So I know you guys know that, but it is your job. By the time you’ve kind of graduated someone from your program or discharged them from care, that. Are in a there are in a regulated place. So just want to make sure we’re being clear about that, that distinction,

Barrie Bondurant 35:07

this is so helpful to me. I’m talking to my first person who may do cap with me, and she has complex trauma, and I’ve known her forever, and I was talking about the dysphoria, dysregulation piece, because I see that as something that almost certainly will happen for her. She doesn’t feel safe, hardly anywhere at any time, maybe never. And she told me that she’s been playing with psilocybin, and she has terror and panic, but she’s proud that she gets through it and comes out and does it again. And so I really like thinking about dysregulation, possibly as just being a way that that a person learns to strengthen themselves by learning to tolerate it, and it’s just quite lovely. And with the ketamine and the expansiveness, it seems like a perfect place to do that.

Dr. Signi Goldman 36:10

I love, I kind of love that you say that because I am an exposure person, as you guys know, even on on ketamine. But one of my things that I have learned doing exposure work with people is that it can be an empowering experience, even if it’s not fun. And then a lot of times, even when people have, like spontaneous fear based exposures, just spontaneous exposure experiences, they will be very afraid, like, I’ve even had called maydad in and be like, okay, this person like, and we’re doing all the things we’re doing acutely that you guys asked about, like, reassurance, all the you know. And I will think afterwards, like, oh, man, that’s rough. This person’s never gonna come back. And it’s, it’s surprising how, almost always they’ll say afterwards that they’re so glad it happened, that they feel stronger in some way. And they, they almost got because some part of them believed that they could not do it, and they could never do it, even unconsciously. And now they, they feel a shift around that. And so, you know, just putting, putting that out there, I’ve seen that quite a bit well.

Dr. Sandy Newes 37:15

And another kind of, you know, sort of, I think it comes out of some of the somatic schools of thought. But is also look, you know, look for the helper. But more than that, I would say, like, look for the can you do watch very carefully when you have like a, you know, like a going into the content and, you know, kind of a, you know, reliving of that, or whatever we’re going to call that, like re, you know the exposure piece on that watch for the moment when they started to free themselves, because that will almost always happen, and that might even be just a cognitive shift. For example, I was working with somebody who was experiencing abuse in the family, and there was a moment in which they started locking their door, and so I noticed that, and I was like, you know, so you started locking your door, and that came up that became a big integration piece. So be tracking, like, when did it shift? When did the story shift? When did they know they were safe? And that’s a very like, you know, kind of somatic tool like, and that’s a that’s a good like, if somebody’s really just like looping on the content, we can start to watch for that. And I don’t mean necessarily interrupt, but watch for that, because out of that comes the work and integration that can emerge, and often does around restoring it. Like, you know, I fought my way through this. I survived. I am a survivor. I was saved. I would look for the moment when they were finally safe. And that’s that’s also then kind of your sort of runway, kind of into, kind of the way out around, like moving back towards resource and self regulation. And that that happens a lot. And when you can, I think you can lodge that restoring even more deeply into the psyche dirt with altered state work,

Dr. Signi Goldman 39:06

there’s a piece I want to throw in, which is this idea of tethering, which we, I don’t know that we’ve formally taught you, but we’ve referenced it. And tethering is, is the awareness that the client has while they’re altered, that you are present. So this is one of the big differences between like recreational use of psychedelics and therapeutic use, is that no matter what they go through, they know that they have a companion who is checking with them, and therefore they are not alone. And I use the word tether because people often feel like they’re floating out or floating away or leaving, and your their relationship with you is like a rope back to ordinary reality, like they know they have this rope back into the room in the office, where the chair is, where their body is, where they’re going to come back, even if they’re floating somewhere very far from that. And you can do tethering in different ways. One of the things. That the docs at our clinic have said that Sandy and I do differently, which I thought was interesting, is that she uses, like, consistent touch more as a tether, whereas they think that I use a lot of verbal cues to tether people, because I’m kind of saying constantly, I’m right here with you. I’m still here with you, and stuff like that. It’s the same concept, though. It gives the person the felt sense experience that, okay, no matter what’s going on, I can also sense this connection back to my therapist, and they are not leaving. They’re not gone. I’m not, you know, and that actually, I’m bringing this up in the context of a trauma conversation, because that’s a lot of times why scary experiences aren’t as traumatic as they would be if the person had it on their own, because they they are, you’re accompanying them through it. So, you know, we’ve, I’ve had some very intense, what you’d say, exposure type sessions, or people in very intense flashbacks of severe traumas, and they are reliving the fear for sure, and on the memories, it’s very vivid in every sense, sight, sounds, smells, touches, they it’s all coming back, right? And they’re, they’re hyperventilating, and they’re all, all of that is there, but because they, but they will tell me afterwards that they could, they knew that I was also there. And so I just want to name that that’s a skill. And I think where therapists don’t do this well on on a psychedelic is where they don’t have some sort of technique, whether it’s verbal or touch focused, to maintain the client’s awareness of the tether, so to speak,

Dr. Sandy Newes 41:31

I think it’s so important to just kind of put out to not just us but the whole audience, that ketamine can be an incredibly relationally oriented intervention. Like people think, you know, like, there are a lot of people who do like, oh, how could you possibly talk on ketamine? Well, you just do like, and you do it because you built a relationship. You do it because you, you know, done good preparation. You do it because you sit closely. You do it because you’ve told the client that that’s what we’re going to do. And so, you know, when I first started, there would be way more times when clients would sit quietly. So I’m obviously doing something different now that almost never happens, and when it does, then it’s just part of their process. But that piece, I think this actually comes from the PSIP, which is kind of a teaching of Saj What’s his last name? Because rajvi, yeah, that you know, we’re not experiencing this, right? You’re experiencing this with me. That’s also very much interpersonally oriented psychodynamic psychotherapy is that you’re experiencing this. But what’s different is you’re not alone, so really being in there with them and then utilizing that and then bringing that up in integration. What was it like for you to have me there? You know, maybe I want you to feel my hand on your arm, and I want you to just deepen in the awareness that I’m right here with you. And let’s just be curious about how that may or may not shift things and just really getting in there and be sweet and but strong. Like, you know what I mean? Like, be, be, be so gentle, but also, like, I’ve got you like, at the same time, and then that becomes a major piece of the intervention.

Dr. Signi Goldman 43:18

Yeah, I agree. There’s a phrase I use a lot, which is, you guys might find useful, which is, no matter how blank it gets, I will still be here. And that is because what happens, usually, is people get into a fear state is something is unfolding that they feel is going to get worse or more intense or right, like I’m starting to lose my awareness it’s going to get worse. There’s this oh no, feeling that’s often behind. And people will say things like, all right, I don’t I’m going to make this up, but say someone says everything is going black, or I am I’m losing awareness, then I would say, no matter how black it gets, I will still be here. It can get even more black, I will still be here. Or no matter how much awareness you lose, you can lose all your awareness. You can just close down no matter how much I’ll still be here, I’m tracking along like so the no matter how much statement. And then, you know, and this is, this brings us into the topic of dissociation. Because, I mean, this is a juicy topic. This is, is dissociation bad or good or neutral? I mean, do we Is this a bad thing if happens? I mean, aren’t. Is dissociation just another form of an altered state that we can work with? You know, there’s that those are things that are still rich conversations, but if someone is even like scared enough that they are dissociating, I will often even do that there. Like, no matter how like dissociation, they’ll feel like they’re fogging over, or they going somewhere floaty and nice and comfortable, but they’re disengaging from the process in some way. And they’ll often have a visual image that goes with that, like, I’m going into a foggy cloud, or I’m just, I’m falling asleep under there’s whatever it is. It’s like, I’m out of here, you know, in some sort of like, and then I will say things like, no matter how foggy you get, I will still be here with you, or no matter how far away you go. So I will still be here. I use those statements even in those moments as well, because they’re that’s also something that’s new. I mean, they’re used to dissociating and everything goes away. But if there’s, you know, even in those moments, you can, you can be present with them, and that that can, that creates, like a something new that hasn’t been there before, with those experiences, I have begun to think of it as a state with useful that contains useful content. So if someone is dissociating, you can experiment with saying, no matter how dissociated you get, I’ll still be there. I mean, they probably won’t use that word. They’ll use some other word, like I’m zoning out or something. No matter how zoned out you get, you know, I’ll still be there. And then just sit with them and act and like, I have tried this because I was taught this by a teacher once, and just let them dissociate even more, like you can dissociate even more. I will still be here. They’ll be here now. They’ll go, they’ll go really down to a very limited amount of like awareness, they’ll close down a lot, but they’ll still hear your voice, right, especially if you’re on ketamine. So they’ll go to their dissociated place and they’ll say, no matter where you are, how, how, how small and dark you are, whatever words they’re using, I’m still here like and I’ll sometimes check that they’re tracking my voice. And if they say yes, then what we’re doing is we’re, I’m going with them into the association as well, and and a lot of times, then you have to allow them to stay there a long time, because that’s what they’re doing. They’re not in a hurry to come out of there. So you’re just sitting in there with in the association with them for a long time. And sometimes in that place, I asked them the relational piece that Sandy mentioned earlier, like something like, are you aware of my presence here with you? And, you know, how is it to have me here? Or how are you feeling like, how are you feeling towards me? Or what are you feeling at the emotion is between us? Or those kind of questions and and a lot of times what that gets to is, like, whatever their whatever the relational pattern is that triggers the dissociation, you know, and that they often speak from very kind of a young part at that stage. But anyway, I’ll probably edit all that out, because that’s a little deep for Woo, for for podcasting, but it’s a thing that’s really interesting, like, it’s perfect, is dissociation actually a problem. Like, we are putting people in altered states anyway here, and we’re going with them. And dissociating is the bodies, the psyches ability to put itself in an altered state that we learned at some point early on we’re alter state altered stating ourselves when we dissociate, and there’s just as much content potentially in there as there is in other forms of altered states. It’s just that we’re not used to exploring it. And it’s a very slow, very sluggish place. There’s a lot of sitting there. The session gets really slow, but it’s almost like you’re aligning with their ability to do that so that they stay in dialog with you. I think it’s really fascinating. Some of that I did also get from Saj at psychedelic somatic Institute. So plug for him for teaching me enough that encouraged me to check try that more. I’ll put a link to his information, because we’ve referenced them a couple times in here. Would be good. Yeah, he’s really good with teaching the idea of, like, working with dissociation, at least that’s my words. That’s not his. I don’t know if he would agree with languaging it that way, and the tracking of the transference pieces, like Sandy mentioned, pieces, parts. And things like that. On ketamine, I think,

Dr. Sandy Newes 48:45

I mean, I don’t think we should be afraid of it, but you want to track it carefully in ongoing integration in that somebody’s not, you know, kind of, you know, deeply into that. And how you do that is kind of a variety of different ways, but watch for it. You know, utilizing your awareness of the client, are they fully present, or are they, like, super blank?

Amy Nicholson 49:07

I think it’s helpful to notice, like, the different degrees of which, like, like when you come back, like noticing when you come back, and then noticing when you leave, and, you know, tracking the RE Association. And I found that somatically, when you can start to track the RE Association, it’s kind of a trip. It’s really helpful in the integration process, too. And I love what you were saying, Signi, about like your like your voice was such a tether for me during our integrative retreat, and so profound to think about this going into a dissociative state with with a tether and someone with you relationally, to be there with you.

Dr. Signi Goldman 49:51

It’s pretty transformative.

Dr. Sandy Newes 49:54

Yeah, it’s really amazing,

Dr. Signi Goldman 49:56

because it’s new and it’s, it’s i. Gosh, yeah. I don’t even know how, like, have the really eloquent words for that, but it’s, it’s like, that’s the safe hiding place where you hide away from everybody and everything and and a therapist has never gone there with you before. Yeah, right. And it may not that may not be conscious, fully conscious that, but it’s like, it’s a felt sense. They have a felt sense of that. Yeah, you know, I think I’m sure the audience and, you know, listeners have lots of thoughts or lots of, you know, I can see this being contentious in some ways, but it’s how do we think of of what dissociation is? And yes, obviously you don’t want people to live with maladaptive dissociation as part of their outcome.

Barrie Bondurant 50:40

But, you know, to have somebody there with you for the first time, the thing about ketamine that’s been so lovely to discover is how relational it can be, and how interpersonal and how healing of different kinds of relational wounds that it can be, and to have somebody, when you freak out and disappear, that’s right there with you, and in your expansive state, it sounds like it could be amazingly healing to do that and normalizing. You know, I don’t have to be ashamed. I’ve got somebody with me, and when I come out, they’re still there. And it just sounds beautiful,

Dr. Signi Goldman 51:27

yeah, a lot, and a lot of times there’s not a lot of words to it, very somatic. And, you know, quiet those are, yeah, that’s an interesting subject. I don’t want to take up all you guys time on that, but it’s, it’s just a since dissociation is such a thing. Yeah, it is a kind of avoidance, for sure, of content. But I think there’s content in the avoidance, but something I’m curious about too. You

Dr. Sandy Newes 51:56

know, I think it’s really important to say, you know, processing content is only one part of trauma work. There’s the processing of the content. There’s the relational component. Because that’s, you know, what people kind of struggle with in response to trauma is often relationship. It’s often the ability to shift state, to be have your nervous system be flexible in the face of different demands in the environment. So, you know, tracking differences in relationship, working on a relational component, tracking differences in state during session and then after session that, you know, helping kind of clients themselves move away from the idea that it’s all about processing content. There’s a place and a time for processing content, but that digging for the aha moment, you know, that digging for like the thing that’s going to free us, like sometimes that does happen, but other times, trauma work happens in a in a much wider range of ways. And so, you know, just kind of putting that out there, that there’s a lot of different ways to work with trauma, particularly using ketamine. So,

Dr. Signi Goldman 53:05

yeah, that’s that state shift. Sometimes they never have a story at all, like they’ll say, I feel better. I have no idea why. I mean, because you just bypass their whole storytelling, cognitive, you know, part of them, and you worked with, you know, other layers of their nervous system. That’s really

Barbara Connold 53:25

interesting to hear because, you know, sometimes with my clients, I kind of feel that, you know, that’s a that’s an important part of it, but I’ve also had clients who do just seem to get better without the narrative telling of the story, or even it coming to sort of a conscious surface level, but they’ve been processing it unconsciously. So thank you for putting words to that.

Dr. Signi Goldman 53:56

I think sometimes what happens is, even if we’re not doing overt parts work, that younger or wounded parts, that are kind of exiled parts to use ifs language, are getting some healing through the interaction with the therapist. I do think that the interaction is relevant, like Sandy spoke to this, these relational pieces, or the things I spoke to with tracking the person, or the Tethering and all that that there are younger parts that are getting healed without the sort of the client’s sort of conscious awareness really knowing that that’s going on. And so their symptoms just shift right, like they’ll just be less vigilant or less and I think this is separate from the pharmaceutical effect of ketamine, because we know that ketamine has antidepressant, anti anxiety effects for sure, and I’m aware that those happen in clients, but this is more of like a structural personality thing, right? They just they almost like parts of them are, but then, but they don’t know what that is. That’s my suspicion of what. Going on just as like you, like, what you’re mentioning, Barbara, they don’t know that that’s what happened. And neither do I know for sure, because we weren’t actually working with that part overtly. Yeah, yeah, that part access some sort of healing, like, maybe the fact that Sandy had her hand there the whole time and was and said the right things at that moment, that that part could release some sort of vigilance. And we know we never even got to know the part. Yeah. So the last thing is, I and if you guys have questions about this or don’t, that’s okay. But there, I think one of the bigger themes that comes up a lot, that we get asked, Is this dialectic, I don’t know, this back and forth between is, is resourcing avoidance, and on the other side is exposure, re traumatizing. So I think we addressed that in what what Sandy and I spoke to at beginning. But do you guys have clarity questions on that, or thoughts on that, or does it make sense to you that there’s this sort of middle ground, and what does that look like?

Barrie Bondurant 56:03

It seems like it might be something you know, working with a person you know, like, yeah, it can be re traumatizing. It can be liberating. It can be avoidance. It can be learning to be safe. I mean, it seems like it’s maybe not a clear, simple answer, but that with each person, you navigate it.

Dr. Signi Goldman 56:25

Yeah, I do think that. And I I think where it becomes, like, where we get asked it more is a strategy thing, like, how to yes. I mean, maybe the answer is, just track for both those possibilities, and don’t assume maybe that is the answer. Don’t assume that you’re reach on that exposure will re traumatize them, and then don’t assume that if they’re leaning heavily into resourcing, that they’re just avoiding.

Amy Nicholson 56:52

Well, I like, I like we’ve talked I’m sorry. I like what we’ve talked about before in terms of, like, titration and choice points, right? And so I feel like when we’re titrating the the trauma, or there we’re helping our clients learn how to titrate their own experience with choice points, they can still learn to be with those different states, but they have more choice in terms of how to how to approach it. And I think that strategy is really important to just remember that we have that it doesn’t have to go from like zero to to 100 you know, like, there’s always choice points available, right?

Dr. Signi Goldman 57:33

And you remember to you’re referring there to something we teach in the training program about Yes, yes

Amy Nicholson 57:39

points. We learned that from, from LMI titration is something taken from somatic experiencing. But please that

Dr. Sandy Newes 57:50

there’s also the piece about, you know, what is the client’s intention? Are they there to process content? Like, is that the intention that they want to process what happened to them when they were a child, or, you know, this the accident, or, you know, the fire, or whatever it is that happened. And if you’ve done several sessions in a series and the person hasn’t gone there yet, then that becomes, you know, a question about integration. And that might something like so I’m aware of the fact that, you know, you wanted to work on these specific issues. It seems like there’s lots of things that have been coming up around that, and we’ve been working with a lot of recalibrating the nervous system and being able to resource and to be able to regulate and, you know, to be able to tolerate the emotion and to grow the good. And I’m wondering, do you want to really go there is now the time so, and if so, then I say so in this session, I’m going to prompt it more. I might even ask you, are you prepared to go into that? I might say, so we were going to work with this session by going into X, Y and Z. And so I might even start that before they become before the medicine really starts to kick in. So you’re really just like doing it the whole time. So So that’s also, I think, the real benefit of working in series, when we especially with complex trauma, where there’s a lot of different types of things and no not one particular event. So you’re building the relationship you’re building the capacity you’re working with, you know, some of the different frameworks and and watching to see if it naturally emerges, and if it doesn’t, then you ask permission, and then you move into doing that. And even then, if somebody’s like, yeah, they want to do it, but then they don’t really go there. Like, you know, that remains an open question. Is it my responsibility in that moment to kind of move us towards that? I’ve never really had that happen. That happen. I’d sort of had that happen, you know, where we were kind of like doing all of this work around it that was also really important for the person. And so, you know, Bessel van der Kolk has repeatedly said that you can do really good terminal work without ever telling the story. So I think it’s again, there’s a time and a place. Yeah, it’s just doing that dance, because it’s not really non directive, like we, at least I don’t believe it to be we. That’s that’s kind of common in the psychedelic literature. It’s more collaborative, co creation, really, by putting it,

Barrie Bondurant 1:00:16

can I just say one thing? Yeah, I used to be one of those people that thought exposure was re traumatization, and so I avoided it. And now I think that was probably good, because I didn’t have the skills and the wisdom, and I think that exposure is traumatizing if you aren’t skillful, you know that it’s, it’s a very delicate thing, and, and I think that with ketamine and being expansive, and if you’re skillful, then it’s, it’s a beautiful way to do that, and it can be very healing. But that’s just my own personal take on it. And, and I’m very glad I didn’t do exposure, you know, 15 years ago, because I think I would have hurt people.

Dr. Signi Goldman 1:01:08

Well, that’s a good cue for our closing statement, because maybe our closing statement can be, don’t shy away from exposure. Work on ketamine, but make sure that you are skilled at it and that you are also balancing it by tracking resourcing, yeah, resourcing, and then don’t worry about over resourcing people into avoidance, as long as you’re tracking that right, and you’re you’re not basically, you know. So it’s almost like maybe that is the answer is, just pay attention to both those supposed polarities and then continue to be curious about this thing that Sandy and I are curious about, which is, does the is the ketamine sort of facilitating that even happening automatically anyway? What I’m beginning to suspect whether, no matter which way the therapist wants to go, so allow, allow for that, because that’s the client’s inner wisdom, or that’s their nervous system’s actual deep knowledge about how to self heal. Yeah. What I suspect is that on some very primal, primal nervous system level, the healing instinct or wisdom of the body is to is to kind of self pendulate, right? And so they’re they think they kind of do that anyway, yeah. And so don’t go in with too much of an agenda, like we always say, and and be open to it. So thank you guys for for having people. That was great.

Barbara Connold 1:02:31

This was wonderful. Thank you. Any more questions

Dr. Signi Goldman 1:02:36

Any more questions That we’ll see you guys at the next class. Thank you. All right. Sounds good. Thank you.

Amy Nicholson 1:02:43

Bye, everybody. Thank you bye.

Dr. Signi Goldman 1:02:47

Thanks for listening to Living Medicine. We’ll see you again next time, be sure to click Subscribe to get future episodes.