What to Know: Advice for a Career in Ketamine-Assisted Psychotherapy

Dr. Signi Goldman 14:37

I had no idea. And you and I, if we back up our lives enough, we both had that experience at some point ourselves, right, coming out of plant medicine world and moving into ketamine so we can relate. And, yeah, I agree. So many people come to us and say that almost like, like most people, it feels like say that to us. Yeah, they were caught hard by, you know, it being. As potent as more than less than there’s that bias you named that it’s not quite as potent as the quote classic psychedelics or MDMA, yeah.

Dr. Sandy Newes 15:08

And I think another one is, is I have two actually, just off the top of my head. But another one is the really important realization that the medicine session is only one part of it that really skilled preparation and integration, of which the medicine session is embedded in, is, is that those things are, they are the process, you know, and that’s really what differentiates ketamine treatment alone, where you’re just at a med clinic and doing it, or doing it at home by yourself, or however your administration is from cap. Is that really skilled preparation integration with the medicine session being, you know, a piece of that, but those two parts being equally, if not more

Dr. Signi Goldman 16:00

important, yeah, yeah. Those are very true. I would, I would echo those, yeah, and then another one that comes up that we need to, we need to do a separate podcast on probably is how much, like a lot of our trainees, are surprised by, how much trauma content comes up and is processed in a you know, in other words, we often, often get our trainees who who are skilled clinicians and already working with trauma in their practices, saying, oh my gosh, I had no idea how good this was for trauma because of what they learned by going through the trainee process or experiencing it or starting to use it. That can be a whole podcast in and of itself. Yeah, that’s one that I feel like surprises people. Oh, for sure, because

Dr. Sandy Newes 16:41

the prevailing view out there is that it’s not good for trauma. And I would say for people, you know, who just go into a straight ketamine clinic and do it without a therapist or without even an integration support or preparation and integration, some people still have great results. I’ve talked to them, but some people do not, or they just don’t have a lasting result. And, you know, a lot of treatment resistant depression, if you scratch the surface, is really related to complex trauma and PTSD and so, you know, a lot of what we’re working with really comes down to that. Now I have a bias towards that, because I see everything from that perspective. So I have to own that. I’m, you know, one of those people that’s like, everything is trauma because of how it impacts your brain and your nervous system, but, but, you know? And then this realization that, like, Oh, if you’re already working with trauma, like you’re going to be doing trauma work, and you’re simply be applying the skill set that you already have into this novel in an experiential way like because really, it’s an experientially oriented intervention where somebody goes into a non ordinary state. But you could make the argument that that happens in wilderness or mindfulness or rites of passage or vision quest, there’s a lot of non medicine ways that people go into non ordinary states. So we’re just applying skill. We’re doing some new skills, but we’re also applying the skill sets that people already have through an experiential lens with non ordinary state work. Yeah,

Dr. Signi Goldman 18:10

yeah. You’re not going to be doing this work the way I do or the way you do Sandy, or the way you know each person that comes through ends up doing it the way they do it, but we do really emphasize particular skills that are important, that are universal, and also there are some concerns that are universal. So maybe we should talk a little bit about that. I think one thing before we move into, you know, maybe concerns that we both have that we want the audience to just be aware of, whether you come through our training program or you’re just gonna, you know, find a pathway through another program out there. But I wanted to name one other surprise that I feel like people have, and that is that they can actually do it like I feel like that moment at the end where they start seeing clients and they like, like, we always get them coming back, kind of like, oh my gosh, it’s going well. Or I did the session, and it was so great, and they, you know, because I think people are surprised to find out that they have it within them to do this work really well once they are literally just given the pathway and given the mentoring and the like, the specific how tos. And that’s just a really lovely moment. I love it, because I see people’s confidence shift. They go from like, I don’t know, I don’t know if I’m qualified, I don’t know, to going like, I am called into this work, and I can step into this work with authority, and I am doing good work. And I just love to see people make that shift. And so I think to the listeners, I would say, you guys can make that shift, whether it’s with us or another good training program, if that’s where your hurdle is definitely, like, take the journey, take the risk, take the step into, like, shifting this into your career. It definitely is a growing part of mental health. It is the frontier and Sandy. And I can attest the fact that it is really exciting and interesting, and you can do it, yeah. And of course. The other side of that is like you do need to hold this safely, so maybe we should say a little bit about what are some of the concerns that we see out there.

Dr. Sandy Newes 20:10

Great. I mean, you know, the biggest concern that I have is the fact that ketamine is is unregulated, so anybody can do it and and why that’s of concern is that there’s a lot of people doing it who I think don’t know what they don’t know. So, like, for example, you know, like, there’s this interchangeable language around, like, what is ketamine assisted psychotherapy versus ketamine treatment versus ketamine therapy? And that’s one of the places that I educate people, right off the bat, is, you know, there are really significant differences, but we don’t have any standardization of language. So because we don’t have standardization of language, we also don’t have consensus on what one might expect in different settings. And so, you know, the and we also you don’t have, as a consumer, you don’t have an assurance that somebody knows what they’re doing, and a lot of ketamine clinics that don’t have therapists at all make very sweeping statements about the fact that they work with a whole range of mental health issues. And you know, while you might have a pharmaceutical benefit or the experience that yourself might have, might help you in those therapeutic domains, like, if you’re not doing cap, it’s you’re not necessarily working specifically on mental health issues. So so that and that that then becomes reflective of the lack of standardization. Like, you know, I’m sure there are wonderful anesthesiologists doing this work in really lovely ways, and that are really helping people to change. But to say that you’re directly working on, you know, PTSD or generalized anxiety, may or may not that might be more of an indirect effect as opposed to a direct effect. And so I get concerned about that, and that’s not to put down the clinics or the anesthesiologist just because I said that, but, but the lack of regulation and the lack of like need for training or identification of that as even a need sort of implies, as if there’s not that much to learn when there really is, and then to do it, you know, next level, to do it safely and to do it well and to really, you know, make sure that you’re really elevating your client’s outcomes and taking really good care of them, while also taking care of yourself is really important because this is also really demanding work. It’s interesting, but it’s energetically very demanding because you’re really in it with the client.

Dr. Signi Goldman 22:32

Yeah, it takes some self care and some doing your own work on your own stuff, to be able to hold the this kind of container for for someone else? Yeah, I would another concern I have, which is related, but maybe in a slightly different words, is really for you guys who are listening, is it is possible to do harm with this kind of intervention? So ketamine assisted psychotherapy, as with psychedelic assist psychotherapy in general, this being a subtype of that can harm people if done badly. And I think that is not said often enough. We just did an interview with Derek Ronaldo specifically on this topic. So I check encourage you guys to check that out. But those of us who do this work on the ground in full time, like Sandy and I, day in and day out for many, many years, you see cases of harm, and we also see people who’ve been harmed in other settings coming to us and telling those stories. And so I put that out there, because I really we feel ethically that, you know, speaking to you guys as listeners, some of you may be ready to do this, and some of you may not, until you get more training, especially around safety. So please don’t step into doing this work unless you’re really clear that you’ve been trained by somebody who’s taught you how to track for ways people can be harmed and also what to do when that happens. A lot of times in cases like that, the provider is left not knowing what to do about it. I think that’s happening quite often. So, you know, I feel like our ethos, and I know, you know, we Sandy, you and I talk about this a lot, is we want people to have nuts and bolts skills. We want to mentor them into the work and encourage them and let them know you can do this. But we also do. We want to be really careful and not about not cavalierly saying, Hey everybody, let’s just jump right into this. Let’s all do this. It’s not that at all. It’s actually check yourself very carefully and be very careful about how prepared you are from a Safety Sense. So it says it’s like, it’s like that balancing act, like we want you to feel motivated, and we want to encourage you to do this, and we want you to not just assume that you can jump right into it without being thoroughly prepared for how to anticipate harm and then how to hand you know how to handle that when it does happen, and also to. Some of these even even recognize it. There’s a kind of shocking lack of awareness out there in the kind of, you know, population at large right now about how harmful psychedelic experiences can be if handled poorly. I think the media under reports that aspect of it. And so even trainees come in with a bias like, Oh, this is just going to help everybody full stop. And you and I talk about a lot how that’s not that, that is this is not a one and done all, you know, fix all kind of intervention way more nuanced, takes a lot of work on the part of the the therapist and the and the client, and it can be rocky. And both you your own self, you need to be able to hold that risk tolerance and know how to handle challenging so handle challenging situations and how to like show up for your client when that happens, and not just, you know, be overwhelmed by it. So make sure, if you’re going into this field, that you have find a training program or a mentor who can fully prepare you for this

Dr. Sandy Newes 25:58

piece. I want to put a little structure on that. I’m curious if you agree with this, I think that there are kind of three broad areas where harm can be done. One is when people kind of it opens up content that they are unprepared for and that they don’t have the support in doing and they don’t have the relationship with the provider, whether that be just the medical team at a clinic or, you know, even a therapist, that they don’t have the relationship and they don’t have that trust and skill set and the capacity to navigate that. Now that’s kind of analogous to psychotherapy, but it is important, but it doesn’t always happen. People think that that this this intervention is so much about content, and that’s only one of the ways. Another way is the kind of trans personal way, like it can open up sort of an awareness or a questioning or a curiosity, or even direct lived experience of relationship with we can call it the other world. We can call it religion. We can call it spirits. We can call it Trans personal, we can call it mystical. We can call it a lot of things. But this kind of a, what is this, you know, kind of like, Oh no, we’ve seen things that can’t be unseen. Now, does that always happen? Absolutely not. But can it happen? Certainly. And then without kind of a place to land in that, you know, that can be really difficult. And then the third one, I would just call put into a broad category of relational like, people don’t realize how much of a relational intervention this is, and that plays itself out in not only skills, but energetically. Like you’re in the bubble with these clients. Like we are right next to them during the medicine. We are with them. Very intimate, very, very intimate and very requires a very high degree of trust on the part of clients, and for some people, especially those with complex trauma or relational trauma, are going to come in with a high level of hyper vigilance. So recognizing that this, this creating safety, not just like physical safety and medical safety, but relational safety and to recognize just how vulnerable somebody is and how their brains are in a different state. And this kind of like imprinting can happen so they can be, you know, deeply moved, but also very scared or hurt or left uneasy, that can then generalize outside of the medicine session to the rest of their lives. So there’s a huge responsibility to manage your own energy as a provider, and to be really, really careful with with how you engage with a client, and to hold that with such such honoring of the trust that is put, you know, in you to have somebody allow themselves to move into that space with you. And the same goes for our training program. Like we’re acutely aware of that and, and that’s the beauty, I think that’s really one of the, like, less spoken, you know, beautiful aspects of this work, but it’s also one of the dangers, yeah, there’s the content, there’s the trans personal piece, and then there’s the relational piece. And those are really the areas that I see the harm. And just you know, always have to be spoken the fact that, you know, the more widespread use of ketamine there is, the more also therapeutically, the more widespread use there is recreationally, those things are paralleling each other, and we do see addiction, like, overuse of ketamine is bad. Like, don’t overuse it. Like, you know, just because you have a therapeutic experience does not mean you should go get some and then use it a bunch all the time that is going to have an adverse effect. And that is called addiction, or substance abuse. That’s not called seeking more therapeutic experience. Like so,

Dr. Signi Goldman 29:43

yeah, yeah, yeah, that’s you speaking to a phenomenon that’s out there where the fact that ketamine is now being recognized as therapeutic and a psychedelic therapeutic, it can be, there can be a slide among people to go, well, I’ll just do that on myself, and that’s a very slippery slope. So we definitely, we definitely would put up big stop sign for that one. And yeah, the relational piece you spoke to is very important, because we recognize that you guys as listeners are already, many of you trained and varied skilled clinicians. Many of you are therapists, and you understand boundaries and you understand, you know transference and how to hold the relationship a therapeutic relationship in a healthy way. But what Sandy’s speaking to is correct, and that this is different. This is a more vulnerable situation, because your client’s usual guards and defenses are in some ways, taken away from them on a psychedelic and so if you don’t know what I mean by that, and some of what Sandy saying sounds like, Oh, that’s interesting, but I’m not sure exactly what she means, then we would really encourage you to get more supervision or mentoring or training around these pieces, because exactly as Sandy said, this is where a lot of harm can be done. So I’m glad that we were kind of you were able to put that into a little bit more of a like a checklist, a checklist of three things to make sure you’re tracking well. And it’s interesting, you

Dr. Sandy Newes 31:07

know, because, as we say, that I’m also like, you know, and also those same things, you know, that, like double edged sword thing, are also probably the things that differentiate this the most from a traditional psychotherapy intervention too is the fact that those aspects are different, and are a big piece of of, you know, holding those levels of awareness and the things that might really differentiate that, like, what the benefit of the the, you know, the the non ordinary state is the benefit of the medicine session, you know, comes in, excuse me, some of those places. So it’s like learning to work with that and not do harm. But also, then to utilize those elements is probably also the skill set, really, if we think about it, yep,

Dr. Signi Goldman 31:55

yeah. I think it’s a good meta statement. Like those of you listening who want to get into this field, one we’ve said you can do this. If you know that you’re a skilled therapist, you can definitely do this. There is a pathway, and it is very doable, and most of our graduates go straight into practice in their existing practices or in new collaborations. So we know that for a fact, and you will be working with your own new skills and your own like gaining confidence or increasing confidence. We know that because we’ve seen that play out over and over again, and it’s going to work. And part of that journey will be you learning these safety pieces that Sandy and I have talked about, whether you do that with us, but if or somewhere else, and if you do it with someone else, just make sure you do it, and that you have kind of thought through all the points that Sandy just made with, you know, am I sure that I know how to hold that those boundaries that way? Am I sure that I understand how to create a relational container that is appropriate for someone in an altered state? So if, when you hear me say these things, if you have a little bit of like, Huh? I’m not sure what that actually is, then that would be a place to get a little bit more instruction and mentoring, because your primary responsibility is to do no harm and to do this in the safest way possible. It is a new frontier. It is an evolving field. Things may be different in five years than they are now. So those of us who are doing it now are at the forefront of something. And, you know, we’re in many ways, collectively, learning as we go, and I’m sure that will continue to be a thing, but so the foundation of all of that has to be the safety, you know, doing it in a safe way. So before we take off for today, I thought that maybe you and I could just say, What, on a personal level, what kind of moves us about this work, what it’s like being in this work? And I can go first. You can go first. I don’t know. Well,

Dr. Sandy Newes 33:50

let me I want to add one piece to what you just said, too about if you know, if you’re interested, but you’re like, oh, wait a minute, I never came from plant medicine, or I’m actually brand new to this awesome, because that is a lot of the people that we work with are have either not had any experience with any psychedelic medicines or have had very little so. So that is not a requirement. Some have. Some have not. But just know that that’s we actually offer. That that’s what we one of the things that we’re trying, you know, we want to provide for people through with ketamine. So don’t let that most

Dr. Signi Goldman 34:23

providers that are going to get into the legal, clinical ketamine assisted psychotherapy world, just realistically, are going to come out of a kind of like Western trained, already existing therapists who are licensed providers, in the sense of, like, where the field is probably going, so you having had underground experience, might be interesting to you and part of your personal journey, but not really relevant to what you need to get trained because you have a legal psychedelic en ketamine that you can experience as part of your training. Mm. And that is an extremely important part of your training that we didn’t really touch on today, but that, you know, discovering yourself on a psychedelic like, Who are you when you’re in an altered state is a huge part of your learning. And, you know, in our community, we obviously do that by giving you many, many ketamine sessions of very varying types and kinds to, kind of, really, you know, get you to a place where you go, Okay, I know what this is. I know what this what it is to navigate this state. But it doesn’t require you, as Sandy said, to have a pre existing experience with other medicines coming in. In some ways, ketamine is the medicine that you need to, sort of, you know, in the in the traditional underground world. There’s the phrase get in relationship with the medicine. Well, this is the one you need to get in relationship with, if it’s the one you’re going to be using in your practice. 

Dr. Sandy Newes 35:50

Yeah, great. I love that. So what was your question again? 

Dr. Signi Goldman 35:53

Oh, yeah, I thought that would be fun. Was that it? Well, we never really get to ask each other this, so I thought it’d be fun. It’s like, what? What do you find the most moving or compelling about this whole world? Like the fact that you find yourself as somehow a psychedelic medicine expert, right? Not. Neither of us knew in training that that’s what we were going to end up being like. What is that like? Oh, that’s an interesting question.

Dr. Sandy Newes 36:20

So there’s a lot to that for me. One of them is that, you know, this, again, is not everybody’s journey, but there are a subset of us that, you know, my work with non ordinary states is one of the most impactful things in my life. And that is a broad construct, not just medicine, but a lot. And I know that, and I have known that for a long time, so my career has essentially been a lot about exploration of non ordinary states. So to be able to land in this just feels somewhat led, you know, and very mission driven. So there’s a deep gratification about for me, about bringing together a lot of my life experience and who I am as a person with my professional training that feels like a weaving together that is deeply, deeply gratifying for me, but the doing the work piece. So being able, that’s about being able to do the work, which I’m eternally grateful and I’m grateful to you too, for opening, you know, being of one of the portals to that, really, but doing the work with the clients and in the training is about who I get to be as a human, so, and then who that allows the clients to be as a human. Like, it’s a much, it’s a full, like, a full, kind of holistic experiential intervention. Like, you know, we’re living life, we’re having these experiences, and then we’re using the experiences and who we are and living our life and as humans to look at what comes up around that, and then process it and explore it, and then ground it into actual, real life. So even though a medicine session might not seem like real life, you know, we do a lot of work this parallel process concept, which is, how is what’s coming up, and what you know directly associated with what’s going on for you in your life, which is also another separate conversation, but kind of like being able to be authentically in relationship while tracking what’s coming up around that, by being able to be very intimate and really be working with that aspect. And for me to be able to show up in my most authentic, yet also professionally aware and intentionally presented, self presented, that means being aware of the things that are coming up around the relationship is just so human. And then to also, you know, I say this a lot in training, but, like, it’s also really an opportunity to be deeply caring, and if nurturing is a part of you know, who you are, like, we get to be caring and real and nurturing and be nice. That sounds so weird, but we get to be really nice to people. But what I mean by that

Dr. Signi Goldman 39:05

is to be able to, I feel like you’re almost saying loving. It’s like a word I mean,

Dr. Sandy Newes 39:09

like, yes, we get to be loving and sweet and but while also then just very intentionally tracking what’s coming up around that, like I was in tears with a client the other day, kind of talking about the storm and the impact of that. Now that happens for me in regular sessions too, because I actually think that’s just part of being a real human, but those kinds of things happen a lot, so we’re really just in it on a human level, while also really holding that professional awareness and utilizing those relational things with intention, and then this honoring of all the different aspects that can come up, including trans personal, is just really that, to me, is the best part.

Dr. Signi Goldman 39:53

Yeah, it’s it’s therapy, and we’re using our therapy skills and we’re being providers, and they were in office. And all these familiar things, and yet there is something about it that just feels more real than non psychedelic work.

Dr. Sandy Newes 40:08

And so for in people who are sitting there being like, and yeah, that may be summer navigator like, Oh my God, what do you mean? I have to be all sweet and nurturing to the clients. That seems weird. Also know that these are direct parallels to experiential approaches to therapy, somatic approaches to therapy, relationally oriented, psychodynamic like my, you know, PhD work was grounded in an interpersonally oriented psychodynamic model, like, I can language it from that perspective super easily, like it’s, you know, we’re also doing theoretically grounded, you know, technique oriented psychotherapy, too, like, so, you know. And that’s where the I think the interest, like the cute interest, lies, is this intersection.

Dr. Signi Goldman 40:48

Yeah, I think that’s also why so many of our graduates have come out realizing that they can do it, because they already have these amazing skills, and they just have to learn how to use them in a new context. Yeah, yeah. Well, I think I was thinking about my answer for this because I decided, you know, I wasn’t sure if I’d ever answered it either, but, and I’ve never really answered it this way, but honestly, my answer is, um, you know, I think a lot of us as children have this sense of magic, like the world has a sort of magic to it, and that’s true for me as well. And then we grow up and become very learned and educated, science based professionals and evidence based and in the medical system, and there is a sense that, like everything is just treatment for suffering follows an algorithm, and we’re taught the algorithm, right? And there’s nothing kind of, there’s no mystery to it. And I think what this work, it almost is like, I’m still a professional, and I’m still working in a clinic, and I’m using my medical license, and I’m, you know, I’m still in that world, but sometimes I’m sitting in these sessions with people, and I’m, I’m it’s like the that sense of mystery and magic is back at the same time, and I find that really compelling and kind of emotional. So I think that would be my, my actual answer, and it’s probably part of why, similar to you, I feel like I probably have a certain call to be there. And I would say that a lot of you listening, we know that you have that call, because you guys have been coming to our training programs. And I think there’s something that pulls people into doing this that is a resonance there with, you know, it is, it is doing mental health treatment. And also there’s something like sacred space that arrives. It’s not that I created or I am it. It just arrives when someone is in these kind of altered states. And that intersection is really potent, and not something that I ever expected to be able to do in my career, just going into psychiatry back in the day. So I think we can, we can end on the fact that there are skills you guys can learn them. There are safety pieces you guys must learn them. And then there is mystery and magic and and, you know, none of us know what that’s about, but we are all just here, reflecting it back and just honoring that that’s there,

Dr. Sandy Newes 43:23

yeah. Like, staying in the inquiry with it is a phrase I like, like, we’re in this inquiry with the mystery and the magic that is informed by everything else that we bring to the table.

Dr. Signi Goldman 43:39

So thank you guys for tuning in. We’re going to start doing a lot more episodes with sort of questions that the audience is asking. This is kind of, hopefully practically useful for those of you stepping into this field. That’s our intention, and we will, we have one coming up, just kind of debating ketamine for trauma. So keep your eye out for that, and we will see you soon. So 

Outro 44:06

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