Latest / System Speak: Complex Trauma and Dissociation / Guest: Jon Cleveland

Transcript

Guest: Jon Cleveland · System Speak: Complex Trauma and Dissociation

• 0:11
  Speaker 1: Welcome to the System Speak podcast, a podcast about dissociative identity disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to longtime listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 0:58
  John Cleveland completed his PhD in clinical psychology at Nova Southern Eastern University in 02/2016. He is a director of a large group practice in Southwestern Ohio and serves as a clinical faculty at Wright State University's School of Professional Psychology. Over the past few years, John has developed a clinical training program where doctoral students and postdoctoral residents learn to work with complex trauma and dissociation. He serves on the board of directors for the International Society for the Study of Trauma and Dissociation, ISSTD, as a secretary on the executive committee, cochair on the awards committee, and as chair of the research special interest group. John is the former editor in chief of trauma psychology news.
• 1:52
  His published research has focused on the relationship between hypnosis and dissociation as well as the impact of childhood disclosure of sexual abuse on adult functioning. At the moment, he is in the midst of a research project investigating the role of early adversity, trauma, and dissociation in the ideology and maintenance of hallucinogen persisting perception disorder, HPPD. He has presented on these topics at the national and international conferences over the past few years. His clinical approach is psychodynamic, incorporating hypnosis, ecostate therapy, havening, and EMDR. Welcome, John Cleveland.
• 2:36
  Speaker 2: Sounds good. My name is John Cleveland. I'm a psychologist practicing in Dayton, Ohio, which is in the the Midwest US, and let's see. I have a a training program. I think Emma probably already said some of this where I work with doctoral students and residents who are learning to work with complex trauma and dissociation.
• 2:56
  I do some things with ISSTD, International Society for the Study of Trauma and Dissociation. I'm the secretary on the board and the chair of the research special interest group and, do some other things. So, my research in the past has been more in the realm of, dissociation and, hypnosis, looking at the relationship there. But in the past couple of few years, I've been getting increasingly interested in, the use of psychedelics in treating, complex trauma dissociation, but also sort of, maybe how it can how it can go wrong or, you know, concerns about people being harmed by maybe not harmed by the medications or, the psychedelic substances, but sort of, ill prepared for the experience or not having the kind of support they need during it. So, yeah, really excited to be on.
• 3:47
  Big fan of the podcast, and thanks so much for having me, Emily.
• 3:51
  Speaker 1: Oh my goodness. I am excited to even talk to you because you are one of the people that I always see at ISSTD, but also one of the people where somehow we're doing different stuff with ISSTD. So I don't actually see you except for when you're handing me awards.
• 4:13
  Speaker 2: I guess that's what you, have been racking them up. I'll tell you what. Yeah.
• 4:17
  Speaker 1: That's so funny. Oh my goodness. This year, I was funny because I was really intentionally not doing anything last year. It's I was like, how did I get an award? I did nothing.
• 4:30
  But that was fun. It was a good experience, and you and Ben make a ceremony that could just be very long, very entertaining. You do a great job.
• 4:41
  Speaker 2: It's a good time, and I'm glad to have Ben. He's so, sort of, stable and collected, and, yeah, he makes the whole experience less painful for me too.
• 4:48
  Speaker 1: I love it. So tell me, just to just to sort of get acquainted with your story a little bit, how did you learn about trauma and dissociation in the beginning?
• 4:59
  Speaker 2: Oh, yeah. Well, so let's see. That's a good, question. I, you know, I I did research in in grad school with Steve Gold. He's my dissertation adviser.
• 5:14
  But it was a thing where, you know, I'd had experiences in my own life, that led me to have, you know, to be very familiar with with with dissociation, things. Although it was really something that, I didn't really wrangle until I was in grad school. So it was this sort of funny confluence of things. I was interested in, you know, academically and hypnosis and dissociation and and, Steve Gold's research and became involved there. But it was, like, not until I was involved there that I ended up figuring out, you know, how dissociation affected me myself.
• 5:46
  And, yes, that was this sort of two paths, I guess, of, you know, inner discovery and and then working through and also, getting involved with with research, you know, with his team there done at Nova Southeastern University.
• 5:59
  Speaker 1: That is really powerful in some experience, but also that you are one of the people who got an education where people did understand. And I think that's important to point out because we so often talk about they're not teaching this in schools, but some places really are doing a good job. And if you had Steve Gold on your committee, that's doing a good job.
• 6:25
  Speaker 2: Yeah. I felt so, so fortunate. And when I meet with doctoral students, now or or residents, I, you know, routinely ask what kind of exposure they're getting to, you know, to dissociative disorders, to theory, to, you know, assessment and intervention techniques. And, I think you're right. There's, it's hopeful there's growing, you know, awareness and, you know, more and more faculty that are are skillful in these things, but there's still a long way to go, I think, in some programs.
• 6:52
  Speaker 1: So how did that connect to psychedelics, where you're learning about that now? Tell me how that even started, the connection there.
• 7:02
  Speaker 2: Yeah, absolutely. So, let's see. Both in, my clinical practice working with some of my clients who, you know, by and large, have complex trauma backgrounds, you know, and and also also in, you know, observations outside of their, you know, personal and and people I've known. Just seeing how psychedelic experiences, can be sources of of inspiration and growth and hope and discovery, and how they also, at times, again, not to demonize the substances themselves, but in certain scenarios, they seem to uncover things within a person. They sort of lift defenses maybe too rapidly.
• 7:45
  And if a person is, unaware of maybe things from their past, you know, that are, sort of covered over by dissociation, It can be really sort of a rapid process of accessing things that can be overwhelming. And so, yeah, I've just seen it too. I've seen people have such good experiences and transformational experiences and, have been able to use substances like ketamine. I don't prescribe but, working with a prescriber, you know, with clients who are dissociative to be able to take our work even a step further when they're blocked. But again, I've, you know, had clients come in, in really, a shambled state after having a, very unpleasant experience.
• 8:23
  So so, yeah, it was just the past couple of years, I started getting interested in, specifically something called HPPD, hallucinogen persisting perception disorder, after, let's see, would it be okay if I talked about a case?
• 8:37
  Speaker 1: Absolutely. Okay.
• 8:38
  Speaker 2: Cool. So, this is a woman who came in a couple years ago, in her mid twenties, and she's had a really difficult, LSD, experience lysergic acid, sometimes called acid, which is a really strong, serotonergic hallucinogen. She'd taken it recreationally with some friends and her, at the time boyfriend. And, it was a difficult experience. I won't go into, a lot of details, but sort of the most, difficult thing was the sense that her boyfriend was, somehow evil and was trying to physically harm her and, a sense of mistrust involved.
• 9:17
  And when she came in, she didn't remember too much in terms of details of the trip, but she would, she'd been diagnosed as schizophrenic after the trip. She'd, been in an inpatient hospital for a while, was on, you know, tranquilizers, antipsychotics, for a time. Said she really didn't like them. Like, most people don't seem to, enjoy being on them and so discontinued. And in our work together, it was really the primary thing was focusing on that.
• 9:43
  I did think it was curious that she couldn't remember anything in her childhood before she was, maybe around 10 years old. But, again, that wasn't really the focus of treatment. And so we, over a few sessions, worked on sort of establishing somewhat of a narrative, what she could reconstruct from the trip, but a lot of it seemed to be, inaccessible. She thought maybe she'd forgotten it, so we did an extended EMDR session for about two and a half or three hours and, using a CPOS procedure, which is sort of like, fractionation and hypnosis where you're sort of exposing for a little bit and then switching to something else and exposing a little bit until it can be more and more tolerable. So sort of long story short, she was able to recover more and more of, the trip, of the psychedelic experience, the sequence of events that she perceived to have happened, and to experience a reduction in her, you know, physiological distress around it, and to see how, you know, implausible it was, these sort of, conclusions that she drew about people trying to harm her.
• 10:47
  And a week later, she says there were, considerably less situations that seemed to be queuing or triggering this feeling of of of, that it was gonna come back, that the this is pretty common here. Oh, my gosh. I don't want it to come back. That horrific experience. I feel like it might come back at any time, and I'd be horribly frightened.
• 11:05
  So there was less and less of that and after a month or so, it was sort of all but a distant memory. She could recall, you know, the trip, but she wasn't highly distressed in talking about it. But it was around that time she started having, memories of her childhood coming back and specifically, the different forms of abuse that, resulted in her being taken from her her parents' custody. And so, that was really illuminating for me in the sense of saying, wow, I don't wanna take one case and say, oh, all these people who have this condition have histories of childhood trauma and dissociation. But, that's what led me to do, a small scale study, investigating this looking at people that have HPPD.
• 11:47
  And, let's see. Is it okay if I describe that?
• 11:51
  Speaker 1: Yes. Please do, and don't assume I know anything.
• 11:56
  Speaker 2: Oh, okay. Sure. Absolutely. So let's see. So I think it's helpful to for listeners, in case and many may already be familiar, but, you know, this is sort of painted as, like, an obscure neurological condition, but I don't think it's so obscure, because well, because it's there there are two types or subtypes, type one and type two HPPD, hallucinogen persisting perception disorder.
• 12:20
  Type one, some argue is that even a disorder because these it's not really a dysphoric or unpleasant for a person. Happens from anywhere for a few days to a few weeks to maybe a month or two. They have brief periods, maybe a few moments or an hour or two. Well, they'll have some of the subjective, like, the phenomena that come along with it. But, you know, these can be, a burst of of a color, or shifting color that can be, like, semi translucent, superimposed geometric shapes or undulating lines in a visual field.
• 12:50
  There can be halos, around things, a host of different phenomena. You know, importantly, micropsy and macropsy. So things seeming to get smaller and seeming seeming to get larger, which, is not uncommon in, for dissociative people to to have that experience at times. But, anyway, so it's this host of different, visual phenomena typically that happen. But type one people aren't really particularly perturbed by it.
• 13:15
  In fact, some of them will say, this is kinda cool. It's like a free trip. I paid to take acid or mushrooms once, and, now it's coming back to me. So, notably, these people tend to have had enjoyable or, meaningful, like, not distressing, psychedelic experiences and and it it fades over time. So like I say and this happens to be maybe eighty to ninety percent of people with this condition.
• 13:35
  So it kind of resolves itself over time, and it's not particularly perplexing. But type two, which is maybe ten to twenty percent of people with a condition, it goes on for months, for years, sometimes for decades, like a whole lifetime a person could, intermittently experience these visual phenomena and what comes along emotionally is a great deal of distress. There's worries of, going crazy, not being able to trust their mind, intense fear and panic, and there can be social withdrawal, you know, that comes along with it. It can be impairing a person who might not trust trust their judgment, say, if they're operating a vehicle and they're seeing things in their periphery, things like that. So so, you know, if you're trying to get, like, a a figure out, like, well, how many people might be impacted by this, you know, roughly, if we're talking about type two where they're distressed, somewhere between, like, fifty and a hundred thousand people in The US, likely have this condition.
• 14:30
  It's difficult to get numbers because people don't always present, you know, for evaluation and for treatments. And maybe this is, you know, in part because when they do present, it's a lot of, like, moralizing or, okay, well, you you know, you took a drug. This is this is sort of, this is what you get. And there's not a lot of treatment options, offered. Sometimes, benzodiazepines are used or antipsychotics, although the antipsychotics don't tend to be very helpful.
• 14:55
  So, you know, rarely is psychotherapy recommended. You know, it's basically just try to decrease your stress, maybe take some benzodiazepines, and, that's really it. So, anyhoo, so in getting interested in this, I said, well, I don't wanna take this one case, this this young woman who clearly had a dissociated history of childhood abuse, that emerged after, working through this this recent traumatic trip, which I would say was a traumatic experience, maybe sort of like the straw that broke your camel's back or, that one, additional trauma that that her psyche couldn't, continue to manage all of the emotion that was underneath. So, so I did a small scale study online, recruited, 12 participants and who qualified as having a type two HPPD. I had to screen out a number of people with some online survey methods.
• 15:49
  I did offer some compensation, so I required a five or ten minute interview over Zoom just to make sure people were who they said they were, and they qualified and screened out about eighty percent of people that wanted to participate. So, so what did I find? Well, in addition to demographic, measure, I administered the the DES two, which is the dissociative experience scale, second edition, used in a lot of, you know, research related to complex trauma dissociation. I'm guessing users will have some familiarity with some of these things. The PCL-five, which is a, commonly used, checklist to, see level of, symptomatology that goes along with PTSD, so things like intrusive, memories of traumatic stuff, avoidance, you know, also taps into dissociation, effective dysregulation.
• 16:39
  And in addition, I administered the ACE, ACE scale, which is Adverse Childhood Experience Scale, which looks at, it's, 10 different sorts of, difficult things that could have happened in that categories of difficult things that could happen in a person's childhood. So in addition to, you know, varieties of of, abuse, be it physical, you know, sexual, emotional abuse, other things like, one parent was in, incarcerated or, a parent may have had a drug or alcohol problem or, food scarcity, things like that are are asked about. So interestingly, what I found in, the results was or the, the PTSD checklist where, I'm sorry. I'm just looking at my figures here really quick. It was nearly, sixty percent of, at least the standard cutoff, sixty percent of individuals in the study, would qualify as having a current diagnosis of PTSD.
• 17:41
  And it was over fifty percent of individuals had, very high BES scores, like, in the diagnosable, range for dissociative disorders. And interestingly, if I compared, their numbers to a schizophrenic sample, significantly more dissociation than in in schizophren than the schizophrenic sample, which I think is is interesting. It's curious because, again, you know, my client had been diagnosed I would say misdiagnosed as schizophrenic, and I think there's a lot of not that, a psychedelic experience couldn't be, like, the precipitant for somebody that was, like, prodromal schizophrenia. So they had, like, they were sort of, they had that genetic predisposition and perhaps the intensity of the psychedelic experience brought on psychosis. But, you know, so often people are misdiagnosed especially, like, in, poorer communities.
• 18:29
  You know, minority groups are misdiagnosed as schizophrenics, so I think it's important to try to discern is it a dissociative disorder or schizophrenic spectrum disorder. And then lastly, the ACEs, which is that adverse childhood experience scale, where, average person in the general population has, 1.6 or 1.7 ACEs in first childhood experiences, so, like, less than two. Over half our sample had four or more diverse childhood experiences. So, the big takeaway there, you know, again, relatively small scale sample needs replicated with a bigger, a bigger sample, is that considerably more, dissociation, PTSD, symptomatology, and a lot of childhood adversity, in these individuals that, go on to develop this, in the aftermath of taking psychedelics, HPPD, hallucination persisting perception disorder. Okay.
• 19:24
  I feel like I've been talking and talking and talking. I've done it done, I'll be quiet now. But I think that the big thing is we're talking about, like, maybe fifty to a hundred thousand people, in The US who have this condition. In my my my queries, are we talking, like, half or more of those? What if they have, you know, PTSD?
• 19:41
  What if they have dissociative experiences? What if they have a history of childhood, trauma? And what if, the symptoms would really benefit from the existing treatments that we have for, those conditions? So yeah. So that's about it.
• 19:56
  Speaker 1: This sounds really significant for people who have gone through this specific trauma of, like, a bad trip or are getting misdiagnosed because of other things. Do you still like, is this ongoing study where therapists or clients themselves could still refer to you or your research if they are needing?
• 20:20
  Speaker 2: Yeah. I appreciate the opportunity to, to promote it. I'm not, collecting data at this time, but I'm hoping to in, in the next couple of months. I don't have a website or anything at the at the moment at the moment for this. But if people are interested and they want to email me, that would be great.
• 20:38
  I don't know if there's a way to leave it in the description for the episode, but my email is, j cleveland, so the letter j,andthencleveland,cleveland,@mycordell, that's m y c o r d e l l, dot com. And I'd be, very grateful for, anybody who is experiencing these kind of symptoms or, you know, therapists who are are working with these cases. I do consult, here and there, with, therapists that are working with with HPPD.
• 21:08
  Speaker 1: What do clinicians need to know about this specifically, do you think?
• 21:14
  Speaker 2: I think there's a lot of fear that individuals have who who have the experiences, these ongoing, hallucinations, and it's not so much like the visual phenomena that they're experiencing, but it's a great sense of dreaded fear that they might be going crazy, that if, that if they talk about it or get too in touch with it, that it's going to make things much worse. And and they might be, you know, I think it's good to trust your your clients' judgment on things, not to on the other hand, you don't wanna be, you know, I don't like working with, other trauma based conditions. You don't wanna sort of collude or or lead too much into avoidance because that's part of, a helpful defensive strategy, but it can get in the way of treatment. So I think, Jeff Lee, you know, Jeff Lee, you know, exploring, but I really do think that, the working through these kind of experiences may be responsive to some of the tried and true approaches we have. That said, this client that I was talking about was a good fit for EMDR.
• 22:14
  She could tolerate it and we did it in a very sort of paced, you know, way with fractionation. But, in a kind of a caveat, like, working with any trauma using EMDR is that some people will it'll be too much if you lift those sort of dissociative barriers, I think. The psychedelics themselves are sort of you can think of them as, you know, psychedelic, I guess, means mind revealing. But, you can think of it as anti dissociative, I think, because, in the sense people are you know, what we're conscious of is is, you know, kept at bay through dissociation, and that's not always a bad thing. But, you know, too much too soon can, you know, can can overwhelm a person.
• 22:50
  So, I'm not sure that I totally answered your question about what would be helpful for, clinicians to, to know. But I think it is that balance of, you you know, pushing to explore, you know, while not while not overwhelming the person. And, you know, even though I'm, you know, pinning this picture, we're saying, Hey, probably a sizable percentage of these people have a history of childhood trauma. You know, of course, we don't want to be, suggestive or we want to be careful with how we phrase our questions so that we're not sort of, distorting or being too suggestive with, with clients like, Oh, is it possible you have this kind of trauma? Is it possible you have that kind of trauma?
• 23:25
  I think, you know, as in working with other other things, you know, other kinds of trauma, if you explore one thing, and if there are other sorts of, traumas a person is out of touch with, they'll probably emerge in the course of treatment.
• 23:39
  Speaker 1: I I'm so curious about what you said with the connection with EMDR because I know we have talked on the podcast already, so listeners know too, about how if you do BLS or the bilateral stimulation, so the tapping or the buzzers or eye movements or something, if you do that too soon, it can increase dissociative phobia. But is that part of what's happening when someone has a negative experience with psychedelics that it has been too much too soon? Or is that a different thing? Because it sounded like there's a parallel, but I literally know nothing about this. So I was just curious about that piece.
• 24:27
  Is that a parallel process there or something different?
• 24:30
  Speaker 2: You know, I I, I really find what you're saying. Yeah. I think that there's a lot to that idea. I think for you know what? Talking to, therapists who have done their own EMDR, like, you know, been in their own treatment, and had EMDR treatment and and talking to some clinicians, you know, or some sorry.
• 24:49
  Some clients who have who also have had psychedelic experiences. You know, I hear pretty often, like, this is sort of a psychedelic thing that's going on, you know? You know, it it's hard to predict. And I think as a clinician sitting with a client, you know, maybe some clients, single incident trauma, you're really just sort of desensitizing around the details which they're already in touch with. But for anybody that uses, you know, defensive dissociation to, to cope as things start coming emerging and flooding into the psyche, yeah, I've definitely heard that from from others who've had both psychedelic experiences and and any MDR treatment that there are similarities in terms of how things emerge in the mind.
• 25:27
  Speaker 1: So if we, with MDR, would sort of pace that or make sure that we don't hurry into the BLS phase or that kind of thing, how would you do that with psychedelics or psychedelics in treatment? Would that just be more preparation work? Would that be smaller dosing? Would that be pacing things differently? What does that look like?
• 25:51
  Speaker 2: Gosh. I think all of the above. I think those are all great, considerations in terms of how it can be approached. Researchers that are in this area that are interested in how, effective psych psychedelic psychotherapy is conducted typically, break it down into three phases. They say that there's a preparation phase, there is an administration phase, and then there's an integration phase.
• 26:15
  And this is, from studies that, what do you call them? It's not really a meta analysis, but, you know, they're looking for commonalities across these approaches and, you know, preparation can be so important. Helping a person to know what to anticipate, what what might happen, and also getting a feel for, what might come up, you know, with a client. Are they aware that they have a trauma history? Have they had, difficult psychedelic experiences before?
• 26:39
  You know, during administration, there's, from what what I've read from people I've talked to that do, you know, psychedelic treatment with their clients. It it ends, you know, research that looks for these common, commonalities of cost approaches. It is a bit different. It's hard to fit psychedelic therapy into, directly into sort of an existing treatment models. Like I say, you know, you're bringing up the MDR maybe as a notable, notably different because it is very sort of, like, open ended during the administration.
• 27:09
  The role of the therapist is to be typically present, to be supportive, to be encouraging, to impart a sense of safety, to encourage gentle exploration, to be in touch with, sort of I don't I haven't put heard it put this way, but really the window of talent, helping the person to not feel overstimulated, but also encouraging them to move forward. And there are times where things are quite quite quiet, and there are times where a therapist may be active, but it's never, a rarely directive. Like, this is what you need to focus on. You know, very much like EMDR. In that sense, in terms of what's helpful for, yeah, I guess you could say, like, modulating the stress, I think the dose is a big deal.
• 27:48
  Some theorists talk about and practitioners talk about something called a psycholytic dose as opposed to a psychedelic dose, where a psychedelic is supposed to be quite intense, mind revealing. Some people talk about ease of ego dissolution, you know, which can be a bit too intense for some clients. The psycholytic dose is something that, where the client is definitely, impacted by the drug. It's loosening defenses to a degree. They're able to engage in ways they would not without the substance, in their system, but they're very much, able to, converse.
• 28:22
  They're able to engage, and, in sort of a modified talk therapy. I think ketamine, is shows a lot of promise for this. It's, you know, it's really the only, legal, prescribable psychedelic, at least, for the next few months, MDMA and psilocybin are in in the pipeline for FDA approval. And there's an infrastructure that's getting built around, treatment centers that'll be used to administer these substances. But, ketamine's out there for sort of everything right now.
• 28:51
  There's pluses and minuses there. There's a whole, private equity funded industry that's setting up hundreds and hundreds of clinics everywhere. Norm Norman Alessi, who's a psychiatrist in Ann Arbor, Michigan, who has a ketamine treatment center there, presented me with me at the ISSTD conference, and he's been doing some, really interesting stuff. And like a lot of psychiatrists, he really sits with, his patients as they're as they're under the effects of ketamine. And he's using these psycholytic doses in individuals with quite a bit of dissociation, either OSDD or DID, and, achieving really favorable, results.
• 29:26
  So he's, I don't want to say I don't want to misquote him, but he's told me some interesting stories about being able to make big progress with patients in terms of accessing, parts and having them be able to be more agreeable with each other and less sort of, polarized and things like that. So I think there's a lot of lot of potential there. And I do know that ketamine is used, maybe not in, would you say, clinical settings or in research settings, but there are sort of these. Now, undergrad has a bad connotation, but there are places where psychiatrists will, work with therapists and administer psychedelic, experiences to people looking for growth and for healing. And sometimes if they're using drugs like, LSD or psilocybin, they'll keep ketamine on hand in case the experience becomes too strong and, in order to, you know, to to to moderate it, to to decrease the intensity.
• 30:20
  I'm not sort of endorsing that or saying that's best practice or legal or anything like that, but that's something that I've heard about. The suggestion is the idea that that you had there about, you know, you know, dosage, you know, setting, what's being focused on, you know, the the role of the therapist in helping to help the person to, tolerate the intensity of what's coming up to feel feel safe and, yeah. Yeah. So all good all good ideas.
• 30:45
  Speaker 1: I I I have a couple of things I wanna say in response to this. One, just I love the gentleness that you're talking about how to care for people in it and sort of the relational aspects too of safety and connection through the experience. And the reason that's important to me, well, there's lots of reasons that's important to me. But one thing I just wanna acknowledge the congruence of is that is my experience of you generally. Like, we are on different committees and and things with ISSTD, so I've not gotten to spend, like, tons of time with you.
• 31:18
  But all of my interactions with you, I have always felt entirely welcome and entirely safe. And sometimes, lots a part of me, like, hanging out with, like, you and Ben can be pretty fun sometimes. And, like so so, like, this I just wanna acknowledge that it is a safe experience because I don't know if it's because this is just unfamiliar content to me because it's something I don't know as well cognitively, or if it's just because we've been through everything of the last year of sort of noticing and acknowledging, relationships with clinicians and what feels safe and what feels good, and that is an example of it. And so I just wanna point out and make explicit. Maybe I'm overstating the obvious, but it feels important to me to make explicit that what you are saying and suggesting and recommending is congruent with my experience of who you are already, which for me adds validity to it.
• 32:22
  Does that make sense? Is that okay if I say that?
• 32:25
  Speaker 2: That is more than okay. That's, like, so, meaningful and touching, actually. Thanks. Sometimes I worry. I have a tendency of, like, dig a bowl in a a china shop.
• 32:33
  So, yeah. Thanks. That that means a lot of them.
• 32:36
  Speaker 1: I just I just I'm I'm in a place, and I've talked about it lots on the podcast. Some of it will have aired by the time they hear this. But I just wanna acknowledge it because I've been in a place for a while now, really trying to pay attention to my body and really trying to acknowledge what feels safe and what doesn't. And we've talked a lot on the podcast about unfawning and things like that. And I just wanna say that it really has been a consistent over the years with ISSTD experience for me with you.
• 33:11
  I don't I don't mean to get off topic, but, like, when we talk about ISSTD, sometimes it's like this big entity. And when I keep saying on the podcast, like, it's the people. It's the people. Like, you're one of the people, and you're one of the people that make it safe and good. Even when we're talking about something I don't have any idea about and I'm learning from you, you're one of the people that's like, that's why I go back.
• 33:37
  That's why I'm involved with ISSTD. That's why it's safe enough. And I just needed to say that because what you were saying about good care of people matches for my experience with you. And I just wanted to say that. The other thing I wanted to just sort of follow-up with, for people with lived experience who are not clinicians, how do they tell when like, what is a safe place and what is not a safe place to get help?
• 34:07
  Like, is there a way like, we talk about how to find a good therapist who knows about DID or how to find a safe therapist. Like, we talk about some of those things sometimes on the podcast. In this context, where some of it is just, like, sort of an opportunity is being appropriated, and these are my words, not yours. And, these places are popping up all over the place, but they may not necessarily really be informed about something like psychology at all, much less trauma and dissociation. How does someone know where it's safe to actually go to rather than just the place down the street?
• 34:43
  Speaker 2: Ash, what you're wondering about is so important, and I'm really concerned about this too. And I think the way that you put I've read the exact words, but really it is, and I I feel happy about saying this, like, there are definitely treatment centers and providers that are, you know, opportunistic and are I've heard Norm was telling me about you know, because he and I have been talking to people from, psychiatrists that run different, ketamine treatment centers, like, different parts of the country, just trying to get a feel for what people are doing, you know, and their standard protocol. And he was telling me about one, and, I don't remember the state, but where they have this sort of, like, ninety minutes soup to nuts. That's, like, the whole thing from the time somebody comes in, has their intake preparation being administered, like, the dosage of it. They're monitored for when they come down, and then they're discharged, and that's it.
• 35:29
  And it's cash only. And it's, I really worry about just how, an encounter of an intake, history can be taken, how much work can be done afterwards because the thing that I glossed over, which is so important, is, the last of the three phases from preparation to administration to in to integration. Integration really is so key in a lot of, well designed I would say well designed studies that are really helping people like MAPS, which is the Multidisciplinary Association for Psychedelic Studies. The studies that they've, published in, last year in 2021 showing, very high efficacy of using MDMA, in treating, severe PTSD and moderate PTSD. These, studies, after the experience itself where there's a lot of support and encouragement, there are, you know, many hours of integration that are provided afterwards.
• 36:24
  You know, the next whole day is different integration activities, you know, with, with with therapists, alone, you know, in groups, and then they're checked in upon anywhere from fifteen minutes to, like, an hour each day following up, afterwards to, really, address whatever's come up in the course of the psychedelic experience because, you know, it can be evanescent. It can fade away. So there's the thing of wanting to make sure that really maximal gains are achieved, that you're really able to work through, all the good, important things that have arisen and of course the experience, but also to address any kind of adverse experiences and adverse experiences sort of like the, the lingo, the, or bad trip, if you wanna call it that. So, you know, it's not really known as a bad trip, so unpleasant at the time and lingering for days afterwards. And I would say these are cases that can turn into HPPD, hallucination persisting perception disorders.
• 37:16
  So like I'm going off on a tangent, but the question of how does someone know, you know, if somewhere if they're gonna get good quality treatment? I think these are good questions to for a person to ask about, you know, what's you know, how are how are clients prepared for it? How many times have they seen? What sort of integration or aftercare is is available? I would say for and again, because really, the only, legal psychedelic treatment that you can do right now is ketamine.
• 37:45
  I think that I I never like to tell, you know, clients, it's just so or traumatized certain people, like, what they should do with their health. And I'm certainly, I'm not a prescriber, so I can't, say, what anybody should do with medication. But I think that the at home, delivery, programs for ketamine, places like Mindbloom and Smith Family Pharmacy, I think, some people have very good results. But you're basically taking, the substance, They they do provide some support through a Zoom call during the first session, but there's a potential to uncover a lot and not to have very much support. Although you can sign up for sort of tech support, you know, that's really bad.
• 38:22
  The same thing as having a therapist with you. So I think that if a person's considering ketamine treatment, working with, seeing if the treatment facility provides therapy there or if they're like, New Life Ketamine Centre, which is down the street from here. I was just talking to the owner the other day. They'll allow therapists to come and be with their clients, you know, during the treatment and afterwards. And I think that's that's really ideal.
• 38:47
  Speaker 1: You mentioned integration as that later phase, and I just wanna say explicitly, I think our listeners know because we've talked about it so much, but I also it's still so sensitive. I can't not say it explicitly that we are talking about the integration of experiences. We're not talking about boxing up parts or blending up parts or making people go away. We're talking about integration, like the way the brain stores memory and sensory and what we feel about it and all of these kinds of different aspects of an experience, pulling that together into a shared experience. What would you say to clarify specifically about the integration phase for psychedelics?
• 39:32
  Yes.
• 39:32
  Speaker 2: Thank you. Thank you for that clarification. That's so important. And I know that, there are different views on on fusion, on integration, on functional multiplicity. And so, yeah, thank you for clarifying.
• 39:43
  I I wish there was another word to use other than integration, there because we're not talking about trying to combine parts or, condense them or, you know, blend or unblend or anything like that. That said, you know, if, if, that can be a focus of treatment, if it's something that a person is working towards doing is accessing parts and seeing are they agreeable to, being closer or collaborating in some way. But, yeah, integration really just, insights, that had that have arisen, you know, new awareness of things or connections, that have been made in the mind, not necessarily about parts that may be, moved forward and, like, parlayed into, meaningful changes in the in the person, is, is what it is about. So, and that's so individual, and that's the neat thing. I think it's a neat thing about the MDM Doctor, about somatic therapies, about psychedelic therapies, is that, it's really built on the, the implicit belief that or explicit belief that that people have what they need within them to heal, and that if they're unblocked, if they're able to, if it's facilitated, that they can access these things and make make sense of them, that the positive things will will, develop.
• 41:00
  So it's really not a top down therapist as the expert. This is the kind of conclusion that you're going to come to. It's it needs to arise from within, the person they work through. And sometimes a group format can be great for that. There are integration circles probably in multiple in every major city now if you just Google integration circle, you know, where people will get together on Zoom or online and talk about the things that they've been discovering, about themselves in in a group, context.
• 41:26
  And that can be really, helpful. Talking it through with your therapist or or whoever is, there as part of, you know, the study or the, the treatment, facility can be can be good.
• 41:38
  Speaker 1: This is another example of good and healthy appropriate peer support. Yeah. Totally. I love it. I think I think sometimes when we talk about integration, we talk about inclusion, like, including all parts of myself.
• 41:51
  Sometimes I talk about it with words like accessibility, just being able to access what's there. And sometimes it's more about, like, that shared experience and the transformation that comes from it. And I I could talk more about that, but I think that will go way off track. Is there anything else that we did not get to talk about that you wanted to be sure and cover today?
• 42:16
  Speaker 2: Oh, gosh. So this is not my research, but it's, CJ Healy who presented as part of the the forum with, Norm and I, whatever that was a couple weeks ago now. I'm not sure how long ago it was at ISSB, but he has been doing with Wendy DeAndrea and, some colleagues at the New School really interesting research that is based on, it's sort of a survey. It's an online research for recruiting, but individuals who seek out, who have a trauma history, who seek out, psychedelic experiences in group formats. You talk about the power of, being around peers, either like a, the traditional ceremony, like for Ayahuasca or Ibogaine, or in, like an electronic, music event, a rave, because they don't call them raves anymore, EDM event that, explicitly are taking, a certain type of substance to try to, encounter obstacles within themselves.
• 43:10
  There's trauma, oftentimes there's, like, difficulties socially, and I don't have the stats in front of me, but found, you know, regardless of the substance, a lot of, the important thing was, like, decreased shame in these individuals, from being around others, taking these, substances and feeling a sense of, interconnectedness. So I think that, while there are caveats and it's maybe a good idea to talk with your therapist about whether it's a, helpful time or a precarious time to take a strong, psychedelic medicine, there's a lot of, good that can come from people, seeking out their own paths to healing too.
• 43:47
  Speaker 1: I love that so much, the connection that comes from just being together in shared experience and how that really, aside from everything else, just levels the playing field that we're in this together and that there's not shame because we have this shared experience where we can talk about it in different ways, and there's more and more research coming out about peer support that really validates that. And I love that that's being included in this community, it sounds like.
• 44:16
  Speaker 2: Absolutely. It's a really exciting time.
• 44:18
  Speaker 1: Thank you so much. Anything else that you wanted to include? Or
• 44:23
  Speaker 2: I think I think that may be it. But, again, I'm I'm so, I have so much gratitude for what you do, and, it's been awesome being on your show. Thanks so much, Emma.
• 44:32
  Speaker 1: Thank you. Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemspeak.com. We'll see you there.