Why Psychedelic Medicine Needs Training and Safety With Dr. Signi Goldman

Chad Franzen 6:32

So I was going to ask you, like, how do you how do you integrate evidence based practices into this kind of approach with your work? Or did you already kind of answer that question?

Dr. Signi Goldman 6:41

Yeah. I mean, I can answer it in a bit more of a detailed way, and that is that, to the extent that the science has come out, the protocols right that are used in the scientific studies, and sort of, there’s, there’s evidence for, for example, particularly with ketamine, which is one that we’re using the most because of its legality. And when I say we, I mean the field as a whole, certainly in the United States, but mostly worldwide, in the Western world, where this is being adopted. So there’s science and research supporting the dose ranges that you use, the frequency that you dose someone to not expose them to, say, addiction risk or something like that. There’s actually studies around the therapeutic interventions in the sense of, like, how, how much preparation is being given before you’re given the medicine, and then how many sessions you have after the medicine, to sort of into what we call integrate that and make sure that you’re you’re safe around that, how they factors, like set and setting, which means, like, how you know what’s happening in the room, what’s happening in the person’s internal preparation, the interactions with the therapist themselves. All of these things have been modeled in the research studies that have come out. And so we’re not making that out wholesale. We’re, you know, we’re taking from those research studies and using those, those protocols and those those kinds of what we call evidence based ways of working with this with the psychedelics in our clinic.

Chad Franzen 8:07

So you have created a video teaching series and certificate program for ketamine assisted psychotherapy. Tell me a little bit more about that. How did that come

Dr. Signi Goldman 8:16

about? Yeah, that actually came about because I was one of the early adopters of ketamine assisted psychotherapy. I think in the country, it’s a relatively new field, and it’s evolving as we speak. And it came about because I kept being approached by people who heard about this, either just word of mouth, mostly locally or regionally, at first, and wanted more information. And initially it was just people saying, hey, let’s get lunch. What are you doing? Or, Hey, can I come over to the clinic and see what you’re doing? Or people were really excited about it, really interested in it, and had no idea how to dip their toes into it. And when I say people, I mean other providers, other clinicians, who wanted to understand how to how to adopt this. And so I did an informal training cohort with a few people that were pulled together through word of mouth some years ago. And what happened then is I accidentally stumbled into this giant demand, because there’s a there’s a gap, there’s like a bottleneck. Right now, a lot of people who want to get into this work, and what’s missing is adequate training or an easy entryway into it that is safe and like fully fully developed. So I really created the curriculum, and I have a teaching background way back in my life. So I created the curriculum initially for people that we wanted to train, to bring into our clinic and our community, our practice community. And it was, what would when everyone need to know to do this work? What would they need to know to do it safely? What are all the things that I would want someone working for me to understand? And what came out of that almost immediately, is that you can’t train in this work unless you’ve had experience yourself being in an altered state. And so that got worked really early on into our ethos. So we teach people that come and work for us. Through getting them on the medicine and teaching them to track what the experience of being altered on a medicine feels like, and how to navigate that themselves and all kinds of different contexts and doses and sentence settings and things like that, so they fully understand what their clients may experience. And then the videos came out of helping them track the things they need to learn while they’re in the altered state and when they’re not in the altered state, and how to how those things kind of weave in with each other. So that got created initially to train, you know, the sort of people who are coming to me just through word of mouth. And then I joined up with Dr Sandy Nuis, who I’m co hosting the podcast with, and we formalized that training program about three years ago. More, more, you know, for the like, we basically were, like, it was really funny, like, oh my gosh, we’ve got all this demand, you know, we’re being told we’re really good at this. We do know what we’re doing. And there’s this, you know, people need this. And so we were getting this feedback from people who are training with us, saying, This has changed my life. Like, I’m actually launching right into a career. I’m coming in. I’m doing this work with you guys. You’re getting me on the medicine, you’re teaching me all the things I need to know, and then you’re showing me how I can do it and how I can literally start seeing clients. And we were, we were basically getting our graduates were just launched right into seeing clients. And so they were really changing their their professions around it. And so we started getting this feedback, and we go, oh gosh, we should formalize this. We might need a website. We might need an admin assistant. And it just turned into that. So it’s been, you know, in some ways, really gratifying and also humbling, because, like, we’re scrambling to figure it out in a way, like we’re clinicians, we’re not necessarily like business people. And so it turned into this thing that grew itself because people just kept showing up. And so what that really speaks to you, to me, is there’s a real hunger for mentoring and knowledge out there. So that’s a long answer to how that video series got created. But the video series now, it exists as sort of crystallized things that you need to know to do this well. And so it’s become the sort of foundation of our 101, curriculum. But it is important to say that, you know, you can’t just watch videos and do this. You have to watch videos in combination with doing the medicine yourself. And that is, that is really the backbone of our curriculum, so that, and now we teach sort of various levels of training based out of that initial seed curriculum. So if somebody

Chad Franzen 12:27

decided to pursue the certificate, what kind of, like a maybe a time investment is that

Dr. Signi Goldman 12:35

there’s different entry points, but the minimum time commitment is a 16 week and kind of deep dive intensive training have. There are people who do, who come to retreats or introductory offerings before that, but the 16 week is really the core of what you would be required to be certified. And then after the 16 week intensive, which involves seven experiences on the medicine yourself that are assigned to enforce certain curriculum teaching points. So it’s not, you’re not just put on the medicine just to be on it. You’re put on it to enforce teaching points. And you have to, you have to actually journal and track that and report back. So it’s very hands on. It’s very mentorship based by the time you come out of that, you then have to have three clients that you see under supervision by us to make sure that, like we’re we’re eyes on your process and seeing how you’re doing and you’re having our feedback, and after that, we consider you certified. At that stage, our graduates usually are taking clients on their practice, and they’ve pivoted to being ketamine psychotherapy providers. So it’s by the time you get through that process you should feel like when you get to your office and you have a client and you’re in an altered state and you’re in a room with them, that you know what to do, you have a certain confidence and that there’s no hesitation there. That’s kind of our our goal is to get is to make that happen for you. So that’s certification. It really is. You know, do this deeper dive training involves being on the medicine involves a lot of teaching and mentoring. Um, mentoring. Start seeing some clients under supervision, and then, and then you’re good, and you can launch. And then we continue to have relationships with our graduates. We’re ongoing mentoring and supervision calls and things like that, as needed afterwards. So it’s really, you know, it’s, we think of it like, you know, baby birds leading the nest, like they launch and they go but a couple times, if they want to come back for check ins, or they have particularly like, challenging cases, then we continue to be available as needed for that. But it’s super gratifying.

Chad Franzen 14:31

Yeah, very nice. That’s awesome. So you have been trained as a rites of passage guide you. Maybe your audience already knows the answer to this, but what does that mean? Actually,

Dr. Signi Goldman 14:40

most people don’t know what that means, rights of rights of passage. The term rights of passage really comes from what we now think of as more like an indigenous cultural way of living, a more animist way of living, without going too much down the rabbit hole of what that means. So a simple way to think of it is a common rites of passage that you see today would be like what we call a vision quest, right? Or someone goes out on the land and fasts, or is in solitude with nature and comes back, but it’s held as this very as a ceremony to mark a life change or a shift inside the person, or something really meaningful happening for them that they want to navigate. But a rites of passage can be anything meaningful in life that is ceremonialized. In some senses, baptisms or weddings are also rites of passage. Right. Going off to college is a rites of passage. But we, you know, we don’t think of it that way in our culture. So the understanding in the indigenous worldview is that when people are going through anything transformative in their life, it helps to be supported by a community that can ceremonialize that for you and formalize it for you in a way that lands in your psyche in a healthier way. And so taking people out on Vision Quest is is that. I mean, usually people come out on vision quest when they are really want a shift they want, or they feel a shit already happening, and they want to make it real, right? And so I’m trained in how to hold it’s really if you think about if someone asked me, what do you do as a rites of passage guide? I would say we take people who are going through intense live transitions, or want to go through an intense life transition because they want to shed some old way of being, and we create the things that make that happen, and what that looks like is various times of ritual and ceremony. But that doesn’t mean we’re stealing ceremonies from other cultures, or we’re just making it a wholesale it’s really knowing how to create ceremony that’s meaningful for that person so that that does come into psychedelic work. Because if you think, I think there are huge parallels between doing a psychedelic and, say, going on a vision quest, they’re both things that take you out of your ordinary life or your ordinary reality. They’re both things that you need to prepare for, that need to be personalized to you, that you need to be supported while you’re doing it, and have like, a community of support around you, and that when you come back from that that away period, or that altered period, that that time out of your life, you need to come back to someone who can receive you back in a healthy way, make sure You are okay, but also then help you make meaning out of what happened while you were away, what happened when you were out of ordinary reality that is relevant for your goals. What is going on in your life that needs to shift now you’ve gone out in the woods, or you have gone on to a psychedelic let’s think of that as you know. They’re both times out of your life, time away from ordinary reality. Now you’re back. I receive you back. I make sure you’re okay and well, and also what happened on your journey, and how is that now going to impact the change that you wanted to make? So it makes it safe, but it also makes it useful, because we use that like what happened, and how is that now going to weave back into your life? You wanted a change. So this is going to make. This is the change. Let’s make it make a change, right? So it’s, it’s very directed towards creating change in a person’s experience. And so I think, you know, it’s important for the listener to understand that, as much as psychedelics are moving into mainstream modern Western medicine. It’s important to understand that rites of passage, ceremonial work, comes from the indigenous world. And I don’t mean just the extent indigenous cultures, though it is also true of them. I mean all humans on Earth spent most of our evolutionary time in the indigenous way. You know, worldview and cultural Milo so rites of passage comes out of that. Comes out of an indigenous mindset, but the historical, traditional use of psychedelics also comes out of the indigenous world. The modern western world is a new thing anyway, but we certainly didn’t invent psychedelics. We’re rediscovering them. The indigenous world has always had a place for psychedelics, and it always overlapped with what we would now call rites of passage. So it is important, I think, for someone who’s working in psychedelics today as a medical psychiatrist, if you just, if I can be blunt, throw someone on a psychedelic without any of that context, and don’t know how to hold what’s happening, I think you could really create unsafe situations. So how do we learn how to hold that? We learn how to hold that from the, you know, 10s, if not hundreds of 1000s of years of human history that they were doing these kinds of things. So that’s a long answer to say that most people who do psychedelic work, well in a clinical setting, have some kind of background in working in indigenous rites of passage, or even if they don’t call it that, they’re it’s really hard to separate the two. I see my work as this sort of strange melding of Western clinical medicine with. Uh, indigenous ways of working, and that’s the only way that it makes sense, because Western medicine doesn’t know how to alter someone’s state of consciousness intentionally or helpfully. That all comes from indigenous wisdom traditions.

Chad Franzen 20:13

Very, very interesting. So what, what do you think are some of the most promising areas of research in, you know, this kind of psychedelic assisted therapy.

Dr. Signi Goldman 20:24

So right now, if we take the all the science, scientific studies that have been done sort of collectively, it almost sounds like a non answer to say it seems to be helping everything, meaning, the studies that have been done for depression have had positive results for PTSD or trauma have had positive results, and for addictions. And there’s also been, there’s, there have been, and are ongoing studies for more specific types of anxiety disorders like obsessive compulsive disorder, for example, eating disorders, things like that. And for the most part, some of those studies are still coming out. So if I’m answering not in specifics, but broadly, none of those studies are not having positive results, which is a weird way of saying they’re all having positive results. And I think that the reason for that is that it’s actually the wrong question to say, what types of disorders do psychedelics help? That’s a very modern Western way of thinking, like these disorders are very separate things, and we’re used to thinking this treatment works for this this treatment doesn’t, and that we want it to we want to know what treatments, what work for, what disorders. I think what psychedelics are doing is just enhancing the healing process globally. So in some ways, they apply to any mental health disorder. They’re not we’re not giving someone a psychedelic and then just sitting there and letting the psychedelic, quote, fix them. That’s a misunderstanding of how this works. We in this profession are using the psychedelics to enhance whatever therapy we’re doing with the client. So we’re taking existing treatments that are already targeted to specific illnesses, like we use trauma treatments for trauma, and we use depression treatments for depression, but the psychedelic is enhancing it, or almost acting like an accelerant. And so because it’s probably playing the role of an accelerant, it you can apply it in any clinical context to any kind of mental health disorder, if you’re doing it, if you’re doing it safely and get positive results. And that’s what we’re seeing in our in our actual clinic. I think we’re seeing mental health treatments across the board that respond to this as long as the therapist knows how to do it well. So that’s pretty exciting, because it means that some of the more intractable mental health disorders that have had a hard time finding. You know, successful treatments like addictions is a big one, or eating disorders have the potential to do better with this.

Chad Franzen 22:51

Do you see the DC psychedelic assisted therapy the role in the future of psychiatry? Do you think it will just continue to expand.

Dr. Signi Goldman 23:02

Yes, it’s definitely going to expand. There’s no stopping that like that train has left the station, so to speak. Because you can’t, if you have this much scientific evidence that something is helpful, you can’t not incorporate it. It’s almost unethical. You know, the profession’s not this. We live in an evidence based world. If the evidence is that this is wetter, you can’t not adopt it. There is a couple things that are snags with it moving smoothly or rapidly. One obvious one is legalization. A lot of these substances are still illegal, which is why we complete, we teach completely and only with ketamine, because it is legal. And so there’s a lot of, you know, there’s the legalization process moving through with the other medicines on the level of the FDA. And so there’s a time frame that that will, you know, have to be there for that. So that’s one area. Another area that is preventing this from just being widely adopted is the training gap. Because as someone who does this, you would think I would say, oh, I want everyone to adopt this. It’s so helpful. No, I think actually it would be a disaster to just give all the therapists and psychiatrists and other kinds of let’s clinicians out there access to psychedelics right now and say, go. Because actually you can do it badly, and it can really harm people if it’s done badly. So really what’s slowing things down now? One is legalization, and two is adequate training. And I think that speaks to why, when we started a training program and people developed a reputation for being like good and safe and thorough, we got hit with all this demand. And we’re not unique in that there are other really good training programs out there that are having that same phenomenon happen, but there aren’t enough of them. There aren’t and so that that has to grow, there has to be an increase in knowledge and training. And that’s actually the impetus for this podcast, and for us creating more digital online platform and platforming for this community, and for you know, people who are experts to get their voice. Out there with repeatable information, because there’s a huge need for changing teaching is a huge hunger for it. But there’s actually a concern about unvetted or kind of bad information just kind of flooding the airways, because that that happens a bit with something like psychedelics, where they have all this enthusiasm, grassroots enthusiasm, around them, and what, what I think happens, or is it, is it is a potential danger, and I’ve seen a little bit of already, is the enthusiasm gets ahead of the skills, and people start practicing this in ways that isn’t, aren’t, isn’t completely safe, either medically safe or psychia or psychologically safe, and then you get bad outcomes, or you get people getting harmed, which is a very real thing. So what we’re trying to hold in our, you know, in our in living medicine and in the Living Medicine Institute in the trainings, is, yes, the enthusiasm is great. We need more people to do this work. Please come and get really, really thorough training, whether it’s with lots or someone else, please don’t do these things that are unsafe, and because the training is relatively intensive, we spoke earlier to our certification requiring a minimum 16 week deep dive, heavy experiential training followed by supervision. That’s not easy, that’s not expensive, it’s expensive, it’s time consuming, right? All that is just reality. So it’s unfortunate, you know, it’s a hurdle for people to get over getting the training, but if they don’t get the training, then they can’t go forward and safely do the work. And so that’s actually where a lot of the adoption of psychedelics and mental health is getting slowed down because it’s not legality. Is a is a kind of it, it’s a hurdle. But it’s not as much of a hurdle as a lack of training, because we already have a legal psychedelic, which is ketamine. So it’s the lack of training that is the most problematic and um, and that’s really the mission that that inspired us to create this podcast and start getting, like, reputable, vetted information out, but also hear from other experts and other people who are doing it well.

Chad Franzen 27:12

So what are you most looking forward to about this podcast?

Dr. Signi Goldman 27:16

Um, well, one Sandy, and I actually have just discovered that we like talking to each other about geeking out on this topic, with other interesting people who are doing this work. We ended up we’ve done it already, and we end up having a lot of like, symposia or get togethers with people, and these amazing conversations evolve out of it. And so at some point, we’re like, we should be doing this as a podcast. So in some, in some ways, it’s just fun, and we enjoy that. We enjoy, especially when we’re with each other and and talking to other people in our community. And our second goal is, I think our, the mission of our, our organization at this point has been to be the voice of increasing information. Like, what do we want our audience to be is providers, clinicians out there who want to get into this work and want to make sure that they’re hearing from people who are have expertise, who are careful and safe and who can speak with authority about what their training needs are, and then help them understand How to get those things and then continue to enrich their knowledge by like, constantly. This field is constantly evolving. The research keeps being we need updates. We things are coming out in the media, things policy, things are shifting, different medicines coming through the pipelines. What do we know about those? So it’s a field where you kind of need to be kept up to date. And then there’s all these fascinating caught side conversations that come out of this, like, what about the spiritual aspects of this? How do we speak to that with any kind of authority? And who has, who gets to say what that is, and who can talk about that in a medical context? That’s an interesting place to land. You know, there’s, you know, to what the indigenous things are, are relevant here, or are co opted? I mean, there’s so many conversations around that that come up. So it’s, it’s a unique in that this is a medical specialty, but it has all these philosophical, if not existential, implications when, because we are altering people’s reality, and when you’re altering your reality, that’s new in medicine. There’s a lot of implications there. And so there’s these fascinating conversations that are being had in these sort of kitchen table conversations among professionals in the space that I think would be really great to get out to the public, but especially to other providers who are moving into this and want to do it in an educated and safe way. So we feel strongly about it. You may be able to pick that up. And what I’m saying we feel strongly about being really important and important for for this work to go forward in a safe, professional way. And then we also enjoy these conversations, because they end up in some really fascinating, unexpected places sometimes. And it’s a. A rich I feel very fortunate and humbled to be doing this work. I didn’t know I was gonna end up doing this. I thought I was gonna be a psychiatrist, right? Because when I, when I went through residency training, this didn’t exist. You couldn’t go into psychedelic medicine. It, it’s, it’s not something most of us thought we’d be doing with our lives. And those of us who have like found that our lives have shepherded us into this place. We feel a sense of responsibility. Frankly, I see this among others, not just myself, that you know, we’re humbled to be in this role. It’s really potent and powerful work, and it’s humbling to watch. And there’s a sense of if we know how to do it well, but also how to do it safe, and we don’t spread that word. It’s almost like it’s beholden on us to do that. So that’s a lot of the motivation as well. Yeah, awesome.

Chad Franzen 30:53

Well, I know it’s going to be very interesting and informative and valuable, and it’s been great to talk to you today. Signi, thanks so much for having me. Really appreciate it. Yeah,

Dr. Signi Goldman 31:02

it has been, it’s fun. I bet you don’t. You know, talk psychedelics.

Chad Franzen 31:04

Not so much, no.

Dr. Signi Goldman 31:06

So thank you for doing it. It’s been great. 

Chad Franzen 31:09

Yeah, thank you. I’ll talk to you again soon. 

Dr. Signi Goldman 31:11

Thank you. Thanks.

Chad Franzen 31:13

So long everybody.

Outro 31:16

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