Psychedelics, Psychotherapy, and the Power of Kindness With Dr. Phil Wolfson

Dr. Phil Wolfson 20:46

remember, we’re really constricted because we only have ketamine as Legal Medicine, okay, right? Yeah, if we take ketamine and the way it’s being applied administered, there are a lot of people who are not interested in going deep into themselves, who just want to seek from cultural, personal and other reasons. You know, a drug experience, like an Academy experience in an IV center, it’s pretty hard for someone to get away with that in an MDMA experience, you can do it. There are a lot of people drop acid, who drop this thing, of that thing, and who really don’t take time to process, or don’t have the opportunity to process with people where they can explain and experience their what happened to them, and have a notion of someone interested in sharing, etc, right? Feel that that integration aspect, the sharing aspect, for most people, is a very important part of healing. And when you look at the statistics for IV ketamine, for example. And you look at McKinney says meta analysis, 29.7% of people in a significant course of IV ketamine have remission. That’s well within placebo. If you look at the approval that bravado just got now for extension into major depression from not only Dr. d, their experience was under 30% with a 7% placebo response. So look at unsupported psychotherapy, non psychotherapy, treatment with substances that are mind expanding, but used in a drug setting, we see very little. Let me put it differently. We see a poor correspondence between outcome and and the drug experience itself, right? And the nature of the drug experience is not just drug so that’s another mythology the nature of the drug experience. Yes, we think ketamine, for example, MDMA for example, are medicines that have experiences on mind. We know that they mess up neural networks. They do all kinds of weird things. They suppress the one network and expand another. They’re all over the map. That’s why they’re different. At the same time, the besides the actual neuro chemical scramble, I call it a scramble of mind and brain. It’s a very various scrambles that occur. If we look at that, we can also see the properties. There’s a psychological properties Academy. There’s a time out. If you don’t get some reduction of who you are, your ego, you don’t get a ketamine antidepressant effect. The psychedelic effect of ketamine is totally linked, and maybe even on the same receptor site is evidence for that, so that there’s a a balance between what may be a drug effect, and what is an actual emotional psychological effect from who you are for a little while, it’s like an ECT, a shock therapy with consciousness. And the reason that shock therapy was explored sleep therapies with and barbiturate sports. Sport was to take people and give them relief from who they were for some time and scramble their brain up with shock. Does including your memory, right, bring you back? So maybe you won’t start at the same place in. Them, yeah, and so with ketamine, that is the essence of what happens. Even in IV settings. You’re you may have psychedelic experiences, most people do, but they’re unprocessed. In most IV settings, you can process them, but anesthesiologists, who run much of it, much of them, don’t do it. So you have this time out, and you have a bit of relief from who you are, from all that nutty concentration, rumination. I need this. I need that. I ate this one. I love that one. Why don’t they love me? All that stuff takes a little break and then come back. And people were very rigid and tight. Will come back often at the same place, but most people come back somewhat different, renewed. There’s a bit of okay, I’m different with MDMA. The process is different. That’s a ketamine process interesting made. The process is watching self and allowing new material to surface more easily. That’s repressed. So MDMA is a wonderful agent for evoking trauma repressed material ketamine does some of that, if you prepare and you work within a low dose, well, did you go from,

Dr. Sandy Newes 26:29

I mean, did you so you know, you’ve done a deep dive into ketamine, and have been in it for a long time, like seemingly as long as almost anyone. And is that because of legality? Or did you think that CLIN that? Or did it kind of capture your attention in other ways? Well,

Dr. Phil Wolfson 26:47

I mean, I first had my ketamine experience in 1990 it was probably even given my history, one of the most powerful things I ever did. People administered it. Didn’t know what they were doing. I was sick for three days, you know, nausea and vomiting, but I had a profound experience like this is great. Do it again? I’m a Buddhist guy, yeah, always looking at non attachment and what I felt in it, and still see, I can still see the experience was my leaving this body and becoming an energy format and the way in which that visually was expressed, because ketamine at high dosages is a visual experience, internal visual experience, not related to external senses, and there’s died, there’s a commentator watching, and you watch the whole thing. If you don’t, if you’re not able to watch it, you’re anesthetized. You’ve gone too far, taken to medicine, but if you watch it, there’s all this stuff. So I thought I had already had encounters with death, lost a child, and I and so many others, parents, etc, and patients. So I felt, well, I had the experience that seemed like death. I think anesthesia is much more a model for death, but I had that experience. I didn’t need to have more. And I think that’s important for people to understand. You don’t have to do it again and again and again. You have to experience and value what you did. Okay, along comes a group of my colleagues, friends. We form a group, and we’ve been together for 25 years, men’s group, and they weren’t ketamine again some 10 years later, amongst others, and it seemed to me to be a profoundly interesting, a profoundly changeful experience, particularly in a good setting. All psychedelics require a good setting where you’re going to have paranoia and get in trouble. I felt that it had clinical merit and began using it slowly in 2013 and then in 2015 we saw we started our clinic the same time Raquel Bennett came up with the first three year conference. And that was interesting, because at that point I was saying publicly that you needed to have a full psychedelic experience for the antidepressant effect. That was really wrong. I once retracted it, and at that conference, kind of a changing event. Was a man who came on zoom from Tasmania, Stephen Hyde, who just self published the second book on ketamine, called ketamine. A depression, and had had the foresight wisdom to use ketamine orally, which is what he could do in Australia. And he said very definitively, there’s no reason to go through the medicalization of putting people with IVs and monitoring them and doing all that stuff. It’s totally safe at will dose. It’s safe. It has an anesthetic, and let’s do it in the office. And he was very explicit in saying, this is an office based practice accompanied by psychotherapy. Was really convincing. We brought him to the states. He’s a wonderful elder that really shifted the practice into two camps, the anesthesiology and academic psychiatry IV camp, who was still in the war on drugs, afraid of psychedelic experience, which they couldn’t control anyway, kept the dosage low. It’s since expanded in amount to be more effective, and the camp of us that saw it as a psychotherapeutic tool, which we’ve been developing, developing, developing over time, with many, many methodologies, nothing that’s totally specific. No one methodology fits everyone, whether it’s internal family systems or self work or psychodynamic The best thing is to be a people worker and know your person and try and try and work with where they’re at and find the good qualities in them that you love and respect. I love

Dr. Sandy Newes 31:38

that. So back to those humanistic roots,

Dr. Phil Wolfson 31:43

yeah, yeah. Why did they weave?

Dr. Sandy Newes 31:45

Well, I’m not saying they left, I’m just saying, like, you know, it’s clear that that’s really foundational in the way that you think about psychotherapy.

Dr. Phil Wolfson 31:52

I think it’s foundational way we think about humans, right, right?

Dr. Sandy Newes 31:56

Agreed. I agree with you. It’s just, it’s sometimes,

Dr. Phil Wolfson 32:01

if we’re not for kindness in this world, what do we have? War, degradation, monsters running countries, nuclear war. What do we got? Let’s be clear, if we don’t foment kindness in our own exploration, in our being in the world as therapists or people, what do we got? Well, it’s

Dr. Sandy Newes 32:22

interesting because in our training program, I actually tell people I did one of the best one of my favorite parts of being a cap clinician, it is I get to just be really sweet to people like it allows me to be just really nurturing and kind and really sweet, like, I’m right in there, in their bubble with them being, like, super nice, you know, and intentional, but I’m like, holding them in this, this bubble of just like I got you in a sweet, loving kind way. And it’s really that’s really transformative for me on a very human level.

Dr. Phil Wolfson 33:02

But I’m sure Sandy within that sweetness that you, you know, slather people with that there’s also an intensity of concentration around, Oh, for sure, issues are and that’s an envelope within which you work, the most successful envelope in psychotherapy by all measures that you know, kindness, sweetness, acceptance and and thoughtfulness towards the human beings we sit with or are within Our treatment is the most successful measure of of outcome, most successful input

Dr. Sandy Newes 33:45

well. And then if you can also be a really good therapist, good clinician with, you know, good assessment skills, and, you know, good understanding of theory, so that you have a sense about where things might emerge next and how to intentionally use the relationship and some good interventions, then all the better. But I think, you know, like the package is really where it’s at, and that’s what appeals to me, on just a human level, is that it allows more of just the kindness and nurturance to just emerge. So I’m curious. I’m

Dr. Phil Wolfson 34:18

saying how interesting it is to be a therapist, and what an amazing learning curve there is to learning about yourself and learning about human beings and social aspects. I mean, it’s, it’s, you know, it’s a scholarship to self awareness. Mm, ever been? There’s never been a profession like our profession. Historically, rabbis, priests sort of come close, but not really.

Dr. Sandy Newes 34:46

I love can I write that down? There’s a scholarship to self awareness. That’s awesome. I love that. I love that. So couple things I want to ask you specifically about cap. One is. Is, and we can kind of go in whichever direction. You keep saying, like low dose versus high dose. And I’m curious. First of all, just ask you that what when you say low dose, what’s the range, and when you say high dose, what’s the range are you? Are you referring to? Because I think people mean different things.

Dr. Phil Wolfson 35:17

I don’t know if you want specific numbers or not.

Dr. Sandy Newes 35:19

I do actually, because, I mean, people are curious about that. Finish the

Dr. Phil Wolfson 35:23

guidelines that we’re going to circulate. Two guidelines. One is for people who are using and getting in trouble and who are contemplating using. It’s very detailed. And yeah, second guidelines for what I view as the standard of care for clinical practice and played out, we’re going to have an online, awesome of large it’s a big pamphlet, good, thorough. I don’t know if I want to put it as numbers, because the hazard of numbers is that it doesn’t speak to your My sensitivity we, you know, classically, we do ketamine, for example, and some other substances as milligrams per kilogram, yeah, you know that was low ball in the initial ketamine IV world, because they were so scared of people having dissociative psychedelic experiences. But it’s really not about milligrams per kilogram. You’re smaller than I am, and you might need more to have an effect. I’m pretty sensitive. And we very small people who need a lot, and very large people who need much less. So the issue with any psychedelic is what it does to your consciousness, what it does in terms of nausea or side effects, but mostly how you receive it and where the sweet spots are. For benefit with ketamine, the sweet spots are all over the map because the dosage is so flexible and you are very low. So some people are using ketamine a very small number of milligrams. We’re going to use it basically as an intramuscular reference. So if you use the intramuscular reference, some people warming people up for conventional therapy with, you know, four to six milligrams, things that hard we feel. There is no micro dosing. So please, if we have anyone listening, don’t bother with micro dose Academy. So that’s not a thing. So then you have what I call psycho revelatory or psycho revelation experience, which I put at 10 to 25 milligrams, where you can do it in wonderfully, in groups where there’s a short period of being under a significant influence, depending on sensitivity, and you can do actual therapy, much like DMA, in which there’s an ability to interact and a softening, which continues after the major metabolism of the doses on and then you go further up, some people are very sensitive and can’t do much more than 35 or 50 milligrams. I just did a group, small group in Malta, of neophytes on the island. And you know, there were, there were people there who had, you know, really sensitive, and then one who went too far, and she came back and did a lower dose again and rectified her difficulty, and was joyous. So, you know, it’s an art for one, and you know what you’re really looking at is the degree in which you’re leaving the room, or you’re dissolving your ego, and you get into a meditative space. So a completely meditative space is when your external sensory inputs are turned off, and what’s going on is your internal visual, mostly visual, somewhat you can you have to do music, but it’s not always appreciated. Where you’ve cut off the outside and you trip it. You’re on a journey. And ketamine journeys are among the most complete in terms of leaving any sort of relationship to this external world, okay, for a short period of time, right? 25 minutes for the major part, 45 to an hour for them coming down and back. So what is the value of that? Many values, one that really takes you out of yourself and leads you, as you integrate, to an understanding of balance. It has very little reference to. Directly to your life, but it can be as you integrate when you come back, of great importance to who you are. If you’re a depressed person and you go through this ketamine reliably has a an impact on emotion that’s neutral to very positive. So we often say to people who come back, who are howlingly Miserable, coming into Academy experience, then they come back, smiling often and joyful, who say to people, don’t think of yourself categorically as a depressed person. You just saw your work. So open that door to not putting you into a box. Well, that’s one of the things that I see a lot. Like,

Dr. Sandy Newes 40:49

people have a felt sense of themselves as different, yeah, like, actually have, like, a lived experience of experiencing themselves, experiencing me in relationship, seeing their lives differently, and people get into this like aha moment, like as if they’re supposed to be just some insight, when really, I think it’s about the felt sense and the like lived experience of having something different actually occur.

Dr. Phil Wolfson 41:12

Well, Said, I agree, like you go on, so there more aspects to it. So the good quality of even before you take that great leap in terms of dosage and experience is really the sense of relaxation, yeah, letting go of obsessional, ruminative, you know, concentration fears. Obsession with fears, where we are always generating obsessions and judgments and they’re in the background, prejudices, attitudes. People carry trauma, see the world through the lenses of their trauma. To various degrees, we created a an acute PTSD trauma program with ketamine for people in war zones, which has been a little bit applied because just the relief from the awfulness to come back to where your executive functions can override a little bit your reactive amygdala, your reactivity functions, is an imperative for people.

Dr. Sandy Newes 42:27

I teach that to every one of my clients, just about kind of hand model the brain, you know, like blanking on Dan Siegel’s model and, you know, teach, teaching people about that I find super useful. And I’ll just put in a plug, like, post disaster. I did that low dose ketamine that you’re talking about, that acute stress protocol, and it was awesome. It just it did exactly that, like suddenly things seemed like, even though it was really hard, we were making it. So I appreciate that.

Dr. Phil Wolfson 42:57

Thank you so much. And that endorsement is important, because we’re not making people go very far into psychedelics. What we’re doing is creating the potential for a bit of relaxation and passiveness with coping functions which are present but overridden by the drama, by the horror show, that those come back a bit, somewhat back, a bit, right?

Dr. Sandy Newes 43:24

Well, and I know we could go on about that, but I mean, personally, I think that is one of the critical mechanisms, and I find it to be even more effective if I’ve educated the client about it beforehand, that we’re looking for that shift in state, right? That like, shift in kind of an awareness that we’re out of the room in a state. Our body is calmer, we see our environment as different, as less threatening, and that helping kind of open the door to that, I think, is really where it’s at, or one of the big pieces. So I love that you said that. So I want to ask you about what do you think are really like best practices if somebody wants to be a good cap person, and again, differentiating ketamine treatment and ketamine assisted psychotherapy. But I also want to put it in there this piece about we started here, like before we started recording, I would do primarily IV, and I love it. And you do all I am, and you feel very strongly about this, so tell me why you hate IV.

Dr. Phil Wolfson 44:28

Let me correct you a bit. I don’t do I do a lot of lozenger work, the rapid dissolving tablets with our formulating pharmacies, which are all over the world. I often begin people with that as a dosage escalation. I use intra nasal but as I said about Steve, I’ve watched a lot of IV. I’ve experienced IV. It’s it’s not that ketamine can’t be experienced well. Of my intravenous. It’s the medicalization of it. I don’t like that at all. I know I watched, just recently, we were in Barcelona doing a training of Europeans and ketamine work, and I watched a whole series of IV sessions run by a psychiatrist, and he had four people in the room all sitting stiffly in a chair with no music and the drip going and they weren’t even communicating. They were just waiting for the experience to occur and get over. Ketamine deserves to be processed. It’s a very powerful experience, and people, as is the common practice, I’m sure not yours being just in a room, a nurse administering an IV, sitting there, lying there, no music, no aftermath. 50 minutes elapsed, or even 40 minutes the drip is over. You have a bit of recovery. You go home, yeah, okay, you may have some benefit, as I said, it’s about under 30% of remission, a little more for having a significant effect, but it’s a powerful psychedelic, and we’re creating a new world, Sandy, the new which we’ve been trying to create now for Many decades, which is not going too well.

Dr. Sandy Newes 46:21

It doesn’t seem to be currently, does it?

Dr. Phil Wolfson 46:26

It’s a world in which people are thoughtful about each other. It’s a world in which people are interested in who they are, how they think their prejudices, intolerances, tolerances, needs, aversions. It’s a world of inquiry and connection and of recognizing the interconnectedness of all of us, and that’s what I see as being the essential work that I want to promote, and that psychedelic medicine promotes, you wouldn’t the same thing about MDMA. You wouldn’t say, oh, let’s put MDMA people in a chair and drip in the MDMA. You would say that’s against the nature of the heartfulness and consciousness, arousal and trauma work that can be done with MDMA. I’m saying Keta means the same.

Dr. Sandy Newes 47:18

Okay, so, just so people know, like, because they, because, just to play, like, agreed, and like, you know, I, because I work in one, and I was trained in one, they can have an IV clinic, like, where you are we, you know, we have one person in a chair, and the therapist is with them. And the, you know, the prescriber, and the, you know, IV person comes in, like once to set it, and then, like, two times to check it, and I’m doing therapy the whole time. And personally, I think it’s great for because the state stays steady, but that’s really different than what you’re talking another

Dr. Phil Wolfson 47:50

myth. Okay, I’m going to argue with you. I agree on your basic supposition, but I can do the same thing with multiple injections, with intramuscular nature. I can start slow. I can add to it. I can do three of them. And then the myth in the IV thing, which I’m going to take you down the road, is that all IV practitioners have complete control of the medicine. That’s baloney. And IV takes 10 minutes before the effect occurs, because it has to drip in. Once the effect occurs and you’re really happy with the effect, you turn off the drift, the person still metabolizing the ketamine for another 10 minutes. The same thing is true with the im, and the advantage of the im is you’re not sitting there stiff with an IV that’s on there. It has to put up you, and you’re dripping in so, yes, you can make IV wonderfully useful to people, if you wish to do that. I’m glad you’re doing that, but I think, I don’t think you would be hurt by switching to im at all. Probably

Dr. Sandy Newes 48:59

not. I will say that my experience, my like, both lived experience and what I have witnessed and seen is that I am goes for the way most people administer it. And again, maybe you have a more sophisticated way of doing it, but it kind of comes on, like a ski jump, right? And then you’re like, you hit full strength, and then it goes down, and then you spend this part of the session, processing this part of the session, whereas with IV, it’s more like this. So that’s just, I’m open. I’m totally open to like, changing my mind. First

Dr. Phil Wolfson 49:30

of all, we have many, many strategies, lozenges, and we do have people go home with lozenges and the supervision, which really supports the work. So I don’t want to maroon myself and I am and the I process, yes, it comes on quick, but if you use a low dosage, it doesn’t matter. And you know, for the IV, you know it takes time to. Shut it off just the same way. Well,

Dr. Sandy Newes 50:02

it’s definitely more resource intensive, so therefore, inherently, often more expensive, like that. That’s a given, right?

Dr. Phil Wolfson 50:09

Actually, psychotherapy, as you know, is much more resource intensive than having a nurse drop an IV into someone, leave the room, and they get dripped, for sure. Thanks very that’s a gold mine for the people who do it that way. Four or six people in rooms, you got the drip, the docks, nowhere to be seen, and they and they’re getting the nurse there, and they leave in 50 minutes. Next batch people are making 10s of 1000s of dollars a day on that kind of stuff, and this bravado thing is taking all the same way people are making fortunes on doing bravado without really any processing. So drug, it’s not it’s not a medicine, it’s not a consciousness tool.

Dr. Sandy Newes 51:01

Yeah, now I’m with you on that. I mean, I share those concerns, just with the idea, with also just the little bit thing like and I think you can do effective cap at an IV clinic, as long as you’re attending to it. But I hear you that that is not usually the way that it’s done, and I share that view like

Dr. Phil Wolfson 51:17

that. I don’t want to attack you, lively, no, no, no,

Dr. Sandy Newes 51:21

no. This is just a conversation. I find it fascinating, like, I don’t feel attacked in the slightest. It’s just a different it’s a different trajectory. And I’m actually, you know,

Dr. Phil Wolfson 51:33

I’m the road. You’re sort of, you’re sort of the middle way, right? Because

Dr. Sandy Newes 51:38

what I do a lot of is the infusion series with cap. So I’ll actually do six sessions over three to four weeks while doing psychotherapy and preparation and integration. So it’s a really intensive model. So So we’re almost out of time. And so I want to just ask you, what do you think? What do people need to know? Like, what are the best practices for cap? And obviously, that’s, you know, that’s a four day training. I mean, I’m just talking about, like, what do you want people to know? Like, if you’re like, Okay, people you want to get into this field, or you’re doing this work, this is what you need to do to treat your patients well.

Dr. Phil Wolfson 52:14

There’s all the administration and technological issues of which are not very complicated of learning how to do ketamine itself, will need to have doctors or people who really know what they’re doing around ketamine to pass it off as an innocent procedure that has no medical consequences, utility or worthwhileness is a mistake, the more people can practice a full psychiatric approach to people knowing what meds are, medical interactions, you know, and the core issues, more importantly, that people bring in in which They’re suffering, which have all the social, personal, relational issues, knowing when to use ketamine as a medicine, knowing about its potential for diversion and its potential for cravings and dependence, which doesn’t occur in the clinical setting, but is occurring obscenely outside the clinical setting. Great, I see that most importantly, since I’m a psychotherapist, emphasizing that getting to know who you’re with, and then being able to relate to it, non judgmentally, ethically, without needs of your own, and being sympathetic to that, and helping the person warn themselves, know themselves, express themselves, are the major points of view. Whether you do that with somatics, which are wonderful in terms of expressive thing, action before and after. You do it with internal family systems, which a lot of people are learning. You do it with psychodynamic psychotherapy, Gestalt therapy. You know, I like to think I’m trying to learn it all. I never will, but I want to be as broadly thoughtful as to what may reach someone better than another, and what really reaches people is that you find with with someone you’re seeing something that you value, and when accentuate that value in them, you Open the door to them, building trust. So the issue of doing any of these kind of experiences, including conventional psychiatry psychotherapy, is the building of trust. And because people are coming to you and having a profound experience to whatever degree they. Are saying to you, I trust you with my consciousness, with my being, with my life, and you as a therapist, practitioner, want to deserve that trust. It’s not easily given. It’s often fraught with defensiveness and a process before someone yields to it. But the core trauma of human beings is the breakage of trust, loss, the grief overall of that and the ways in which we harbor distrust and see the world through lenses that we don’t always recognize as distrust. So what we’re trying to help people do in the best way we can is establish some sense of personal self trust, awareness of how one has been free and how one is responding to that, and being able to become more flexible and develop ways in which you can work with yourself to provide sharing, love connection and a deep experience of learning and appreciating yourself and others.

Dr. Sandy Newes 56:09

Really beautiful translation of some really complex concepts. I can appreciate your skills translator, being able to translate the complexities into just human terms. And I thank you for that well, and that, you know, so I think that’s a lovely place, just to kind of put a pause there. But is what else? What else do you want to share? Like, what do you want to share about yourself? Or what do you want to share with the audience, or the psychedelic world or the clinical world, like, what’s your message? What do you want to get out there?

Dr. Phil Wolfson 56:45

I have only one message. There is only one way forward, whether we call ourselves psychotherapists and we’re reactive to the traumas happening to people and we’re not prophylactic. We need to also be prophylactic against the causation of trauma, whether from misogyny, racism, you know, inequalities, lack of sharing, cruelty, greed, aversion, whatever it is, we need to develop our awareness and our ability to both exemplify and help ourselves and others to share, be kind, love and show concern for others, the only way forward we were living in An increasingly cruel time with true people running lives, and that’s abhorrent, and I don’t know how it’s going to work out, but I do know that the only antidote to that is not being that way, right? Yeah, yeah.

Dr. Sandy Newes 57:56

So let’s earn trust. Let’s not be cruel. Let’s be good humans.

Dr. Phil Wolfson 58:04

Yeah, I hope I quote you about the IV thing. Oh,

Dr. Sandy Newes 58:08

no, I didn’t feel that’s cruel at all. That’s a professional discussion, and it’s useful and interesting. And, you know, I find it quite fascinating, the whole thing. So, yeah, no, that would did not feel cruel in any way that felt like a professional discussion. So all right. Well, anything else you want to

Dr. Phil Wolfson 58:26

share? Yeah, great gratitude to you. Thank you for having me good well,

Dr. Sandy Newes 58:31

and let me also just give it you know, once again, for people who are interested, Phil and his team do training on ketamine through KTC, the Ketamine Training Center. You can also connect with him through Ketamine Psychotherapy Associates, which is an A group that meets every other week where we do some case consultation and discussion. And then there’s the research group, Ketamine Research Associates.

Dr. Phil Wolfson 58:57

The overall umbrella is Ketamine Research Foundation, and you can get to anything that we can, including our clinic, good,

Dr. Sandy Newes 59:06

good, so you can reach him there and the clinic. And I am just really grateful and appreciative, and thank you so much for sharing with us. So all right. Thank you, Phil, welcome,

Dr. Phil Wolfson 59:17

Thanks.

Outro 59:20

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