Do You Feel Heard in Therapy? Why Trust and Honesty Matter | Chantelle Thomas, PhD

What if the most healing thing a therapist can offer isn't expertise, but honesty about their own humanity?

Chantelle Thomas, Ph.D., a clinical psychologist specializing in trauma, addiction, and psychedelic-assisted psychotherapy, joins Abdullah Boulad for an honest conversation. Dr. Thomas opens up about the family dynamics that shaped her path into this work, including growing up as her mother's unofficial therapist and living alongside intergenerational trauma that touched her whole family. She speaks candidly about the cultures that formed her, moving between South Africa, Canada, and California, and how that shaped her sense of identity.

The conversation moves into what it actually takes to be a good therapist: examining personal bias and shame, knowing how to apologize with real accountability rather than justification, and choosing authenticity over a detached professional persona.

 About Chantelle: Dr. Thomas is a clinical psychologist whose work centers on trauma, addiction, and psychedelic-assisted psychotherapy. Her path into the field began early, shaped by her own family's experience with intergenerational trauma, and has since grown into over a decade of research and clinical practice. Her approach is grounded in authenticity, humility, and a belief that true healing asks as much of the therapist as it does of the client.

 00:00:00 - Meet Dr. Chantelle Thomas: Trauma, Addiction & Psychotherapy
 00:01:34 - Early Life and the Making of a Therapist
 00:05:13 - Intergenerational Trauma and Family History
 00:08:52 - Cultural Identity Across South Africa, Canada, and California
 00:12:27 - The Therapist's Shadow: Bias, Shame, and Humility in Psychedelic Work
 00:16:23 - The Art of a Good Apology in the Therapeutic Relationship
 00:20:26 - Why Authenticity Matters More Than Clinical Detachment
 00:27:01 - Client Intuition and Heightened Awareness in Psychedelic States
 00:32:18 - Training Clinical Teams to Hold Client Feedback Without Defensiveness
 00:35:59 - From "Resistant" to Protected: Reframing Client Behavior
 00:38:38 - A 13-Year Journey Into Psychedelic Research, Starting With Psilocybin
 00:45:47 - Bringing Ketamine-Assisted Psychotherapy Into Residential Treatment
 00:50:05 - Inside the Ketamine-Assisted Psychotherapy Process
 00:56:45 - Witnessing Deep Healing in Psychedelic-Assisted Sessions
 01:03:37 - The Future of Psilocybin and MDMA in Addiction Treatment
 01:09:14 - Dr. Thomas's Own Healing With MDMA and Ketamine
 01:13:20 - Life Outside the Clinic: Balance, Movement, and Music
 01:15:11 - Closing Wisdom: Don't Be Afraid of Your Feelings

Follow Abdullah Boulad:

https://www.linkedin.com/in/abdullahboulad/

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Follow Chantelle Thomas:

https://www.linkedin.com/in/chantelle-thomas-57a31795

You can order Abdullah's books here:

https://www.amazon.com/stores/author/B0BC9S5TCF?ccs_id=c64f2588-7eb1-4592-b4d1-647a0f379b51

Follow THE BALANCE:

https://www.linkedin.com/company/thebalance.clinic/

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#traumahealing #recoveryjourney #mentalhealth #trauma #therapyhelps

Transcript

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Meet Dr. Chantelle Thomas: Trauma, Addiction & Psychotherapy

SPEAKER_00 0:00

I've always been really curious about people and why they do what they do. There was a lot of complexities in the dynamics between my parents.

SPEAKER_03 0:07

Why did you feel you needed to be kind of therapist to your mother?

SPEAKER_00 0:12

Both her parents had attempted suicide. There was a lot of pain in that family system.

SPEAKER_03 0:18

Has it been affecting you?

SPEAKER_00 0:20

Oh yeah. I've been working on the clinical trials with psychedelics for the last 13 years. In the right setting, these compounds can provide resourcing in a way that's incredibly powerful. You move towards the thing that you're most terrified of. Even when clients are incredibly motivated, there are still parts of their system that will fight. The depth of the work that these clients do is awe-inspiring. And they move towards really painful things. Don't be afraid of your feelings. They're there to help you. That's your deepest source of wisdom are your emotions.

SPEAKER_03 1:04

Welcome to the Living a Life and Balance podcast. My name is Abdullah Bulad. I'm the founder and CEO of the Balance Rehab Clinic. My guest today is Dr. Chantel Thomas. She's a clinical psychologist and specialist in treatment-resistant trauma and addiction by integrating psychedelic-assisted psychotherapy in residential care. I hope you will enjoy. Chantel?

SPEAKER_00 1:30

Yes.

SPEAKER_03 1:31

What motivated you to do what you do today?

Early Life and the Making of a Therapist

SPEAKER_00 1:34

Well, I think it took me a little while to find my professional path. Um but it's so funny because I'm a clinical psychologist and people will often say to me, Um, are you are you shrinking me? Have you heard that term before? Yeah. And it's so funny because I don't turn it on and off. I mean, from the time I was very young, I think maybe because of some factors in my family environment, I've always been really curious about people and why they do what they do. I I'm fascinated by people who say that they turn that off when they're just being social or recreational. Um, that's not how my brain works. So I think I've always been curious about human behavior. I think um I was definitely a melancholy kid. Um you know, there was a lot of complexities in the dynamics between my parents.

SPEAKER_01 2:35

Okay.

SPEAKER_00 2:36

And I think I observed that pretty early on. Became an unofficial therapist to my mom, probably way too young.

SPEAKER_03 2:43

At what age?

SPEAKER_00 2:45

Um, I don't know. I mean, as as early as I can remember, I was kind of tracking dynamics, interpersonal dynamics. And I was the youngest child in my family. So and I'm very I from a young age, I've been very focused on tracking the people outside of me. You know, that has some benefits and it has some complexities in terms of knowing yourself versus learning how to read other people really well. But I had considered a number of different career paths, but it it felt so intuitive to go into the field of human behavior and understanding emotions.

SPEAKER_03 3:23

Um I love a good cry from yourself or other seeing others.

SPEAKER_00 3:31

Both. Yeah. Yeah. I'm a big fan of emotions. And I think the most beautiful art that we have and music and theater, it's about moving people.

SPEAKER_01 3:43

Yeah.

SPEAKER_00 3:43

And so this seemed like a really natural fit. And then I will say, specifically to go into addiction work, um, my very first boyfriend struggled with pretty severe addiction and I unbeknownst to me at the beginning of our relationship. And so I think that had a big impact on me wanting to understand more about substance use work. And the psychedelic thing happened already while I was into my career quite a bit, and I had an opportunity to work on a clinical trial. I was not historically a psychonaut, I have way too many control issues to have dabbled with psychedelics. But um, when I understood that they provided the capacity to deepen the work for individuals and to provide access to parts of the psyche that might be really hard to reach. It's hard to go deep. Even when people are motivated to go deep, it's very hard to go deep because of what are you thinking about me? How do you feel about people are still trying to please their therapist? I mean, we're there's so much social impression management.

SPEAKER_03 4:56

Some protection.

SPEAKER_00 4:57

Yeah, and I think to just get relief from tracking out what's out here to really be able to like turn towards yourself is a tremendous gift. And it's a hard thing to do, even with really motivated people.

Intergenerational Trauma and Family History

SPEAKER_03 5:13

Why why did you feel you needed to be um a kind of therapist to your mother?

SPEAKER_00 5:21

That might be a whole other podcast. Um my mom um grew up with a tremendous amount of, I I suspect, I don't even like saying the word uh mental illness, but I think both of her parents suffered greatly psychologically. And um I mean, they just did not have the benefit of growing up in an era where there was clear pathways for receiving help for that. Um I think my mom was the recipient a lot of intergenerational trauma. Okay, and she herself didn't have a lot of avenues for understanding that. And um, my dad is I've said this to his face, a very lovable narcissist. He's very proud of that title, actually. Okay, yeah. Um, they were not well suited for one another, and so um, you know, both her parents had attempted suicide. Um, and there's a lot of pain in that family system and a lot of pain that she had to carry along with her as well. And so yeah, I don't know. I mean, just how I'm wired, you know, I'm kind of a hound dog for emotional suffering.

SPEAKER_03 6:43

I see.

SPEAKER_00 6:44

Yeah.

SPEAKER_03 6:44

Okay. Well, has it been affecting you as a person?

SPEAKER_00 6:47

Oh, their history?

SPEAKER_03 6:49

Yes.

SPEAKER_00 6:49

Oh, yeah. I mean, I don't, I think the more I do, I I think we're just being able to scratch the surface on. I mean, there's good research on epigenetics in terms of what literally gets passed down from other generations. And then quite interestingly, I think this whole um the work of psychedelics is about expanding consciousness and non-ordinary state consciousness. And I've seen that come up for a lot of clients and participants that I've worked with, is not just their trauma, but what they've carried from their ancestors and intergenerational trauma. And um absolutely, of course, that has impacted me, I think. I think I didn't fully understand the impact of it, to be honest, until I had my own experience with psychedelics. Um but I think that's true for so many people. You know, just because especially if if you know that family system didn't have the luxury or the benefit of receiving a way to process, digest, and release, you know, that pain. I mean, we know this too in utero, mothers who are in different kinds of states of psychological states, undoubtedly that has an impact on that process for a baby. And then as early as I can remember, my mom had to move from South Africa when my whole family's from South Africa and they moved to Canada to um as a way to get to the states. My father was a physician and he was sponsored to work in a small town in Canada. They had me. And when my mother left South Africa, she was very depressed because she'd moved away from her whole family.

SPEAKER_03 8:36

So getting out of your environment and safe spaces, probably as well.

SPEAKER_00 8:41

Yeah, I think it was a and it was a massive culture shock. Yeah, to go from South Africa to Canada, Canada to California. That's wild. Yeah, very different.

Cultural Identity Across South Africa, Canada, and California

SPEAKER_00 8:52

Yeah.

SPEAKER_03 8:53

What are the cultural differences? How do you see them today?

SPEAKER_00 8:56

Oh man. Um well, South Africa is such an the the version of South Africa that I was exposed to, because I should I should specify that, right? Um you know, it has a lot of influence, I think, from British culture. And, you know, I came in today drinking tea, but I drink it with you know cream and they love their tea. Yes. Um I think there's also in the version that I experienced, I think there's a really high value on appearance. And uh there's a lot of things that are very considered more proper. I mean, I think um, I remember when I first started wearing a baseball cap, I think that was like, what are you doing? And like what it means to be a lady in that culture, and what it I think the stereotypes around gender are a little more fixed in some ways. And um, yeah, California culture is very laid back in many ways, and um yeah, just a very specific way of doing things. In addition to that, my family also were quite religious, and so there was also the culture of the Seventh-day Adventist Church that I grew up in, and so yeah, I think it was quite a shock for her. My dad is um, I think inherently a little disruptive in his nature. So I think he likes to stir things up, and I think my mom was not from that path. So I think it was much harder on her.

SPEAKER_03 10:27

Where you grow up has it a huge effect on your mental health and how the communities and society would hold it?

SPEAKER_00 10:34

Yeah, absolutely. Yeah, I can't imagine how it wouldn't, because I mean, culture shapes identity, right? And it's it's interesting actually, because I I think my dad was very progressive in other ways, and so he was very curious about the psychology of human behavior as well. There's no question he had a very big influence on me in that regard. So he's very curious about what motivated people, and um, but I would not say that he was the picture of uh emotional embodiment or like that vulnerability was not something I ever saw from him very often. And I mean, I remember attending his mother's funeral and thinking that was the first time I'd seen him cry. Okay, but I think there was a very hyper-masculine identity piece around um what he grew up around. Um like the Boer influence, there's it's a farming culture and there's hunters, and it's a very different kind of type of masculinity. There's some of that in the Midwest, which I've seen, but in a very different way. So um, yeah, absolutely. I think if you're not taking culture into consideration when you're conceptualizing what someone is suffering with, it's a I think it's a you're missing a big piece of the equation. And that can be really hard if you're not familiar with that culture. And so how do you kind of, I mean, this has come up a lot in the work around psychedelics, is how do you operate from a place of humility, you know, recognizing that where I come from, my lived experience, my history, my identity is going to shape the questions that I ask and the way that I engage with a client or a participant in ways that may signal to them that I am I can have certain types of conversations, and there's other conversations I may not be capable of

The Therapist's Shadow: Bias, Shame, and Humility in Psychedelic Work

SPEAKER_00 12:27

having. And, you know, as a my parents being white South Africans, there was a a long lineage of oppression and discrimination and racism. And I don't think I realized how much of that was kind of held in my system again until I started to do more of the non-ordinary state work and how much shame I carried around that lineage. And, you know, when I moved to California, people would ask where I was from. It was a person of color who asked me, I always felt ashamed to name that I was from South Africa as a white person because um for obvious reasons. And so that was also really interesting. I had a big, I don't want to call it an awakening, but I think what I've appreciated so much about working in psychedelic spaces, at least the ones that I've had the privilege to be trained in, is there's there's a real calling to examine your shadow as a human and potential blind spots that you may not be aware of because people move into such vulnerable states in that work. And the ways in which you, when you're not owning your own shadow, the ways you can influence or unintentionally gaslight someone or miss something important, you know, we say, well, this is a safe space. I mean, that's another thing that it's taught me is to presume that safety is a binary concept. You're either safe or unsafe is completely unreasonable because I can be relatively safe for certain aspects of your process, but I might absolutely feel unsafe in other ways. So it's also taught me a lot more about not presuming that because my intentions are good, or I think they might be good or admirable in some way, or positive in some way, that I will not have negative impact on people. And that I think that was really hard for me to understand early on because I had a lot of fantasies about being perfect, and that's a very dangerous place to be as a human being, is and that came from my family lineage. Um, my inability to really attend to potential ruptures or what I'm getting wrong, or how to really lean into missing something important with a lot of humility and curiosity to hold space for someone. The stakes are feel much higher in psychedelic work, although I think this should be happening in all therapeutic work. Like I think all therapists as part of their training should be required to read Harriet Lerner's book on why it's so hard to apologize. Because I do think it's really difficult for clinicians to say sorry. I'm so sorry I missed that in you. And I um I realized what I did had a big impact on you. People idealize therapists as having a lot of power because they do, in many instances, have a lot of power in what they're working with. I've just I've become so much more aware of what it means to hold that responsibly, knowing that I'm gonna still miss a lot of things. But what does it mean to be really ethical and um tracking that with more sensitivity due to the potential impact it could have on the folks that I'm working with?

SPEAKER_03 16:06

I like this idea because it it makes clear that every person has his own uh perception to the world and not what our intention uh is um is providing means you are taking it uh as

The Art of a Good Apology in the Therapeutic Relationship

SPEAKER_03 16:23

such as well.

SPEAKER_00 16:24

She has this wonderful um I don't know if you've ever have you heard of Harriet Lerner before?

SPEAKER_03 16:29

I haven't. Yeah. So summarize a bit.

SPEAKER_00 16:32

Um, well, what she built into this book, I saw her speak in Chicago um one year. And it was, I think it's the nine ingredients of a good apology, which seems like a lot of requirements, but it was really impactful for me because I realized how much of the time when I was apologizing, I was actually just trying to explain why I did something that was hurtful. And her mantra or her kind of like underpinning is why a good apology is so hard is because in some ways it's it shakes your sense of worthiness. She'll say you have to stand on a stable platform of self-worth to truly apologize because saying I got that wrong or I missed something, or I'm so sorry, the impact I had on you can induce a feeling of shame for a lot of people. And it's pretty subtle. I mean, I know the feeling in my body when I can tell I've missed something. And I I literally remember kind of the cascade of feelings that I would get in the face of seeing a client move into anger towards me or frustration. Anger was an emotion coming towards me that was really hard for me. Um and so she has this beautiful map for apologizing, including um she says this other thing, which is if only your desire to understand were as big as your desire for people to understand you. So when something has happened, when a rupture has happened, it's like it's leaning into saying, tell me more. I want to really understand how it impacted you before I quickly get myself off the hook and move on to something else. It's a very powerful thing. And I've worked with so many clients who've said something happened in a therapeutic relationship and the therapist never fully took responsibility for their part in it. So I think this is, we know this in medical research too, right? Physicians that apologize are less likely to be sued, which is a very interesting thing. And they don't want to apologize because they don't want to admit uh culpability on some level, but there's something very powerful about deep accountability because that hasn't happened for so many people in their lives in other areas.

SPEAKER_03 19:03

Yes, it's an interesting point because it's also an apology shouldn't be in uh justification.

SPEAKER_00 19:10

Correct. And uh but you if you watch and see when people apologize, most of the time they're trying to explain why why they didn't intend. It's not important, it's not the most important part. I mean, it can be, but I learned to linger with the impact for so much longer than I would have done historically. And it was always about me feeling ashamed, yeah, that that pushed me to overexplain.

SPEAKER_03 19:40

But don't you think the person or the therapist in that case is not grounded enough to hold that space because it's not about it's not about me when I'm working with uh with a with a client or a patient, it's about him, about her.

SPEAKER_01 19:55

Yeah.

SPEAKER_03 19:56

And and and I have to provide that space.

SPEAKER_00 20:01

Yeah, it's interesting. It's funny because my therapist that I work with at my treatment center will say stuff like that. They'll say, it's not about me. And I would say I I agree with your point to some extent, but it's always about us at some level, right? Like to pretend that we can just be these vessels of intervention without being interpersonally impacted is just not

Why Authenticity Matters More Than Clinical Detachment

SPEAKER_00 20:26

realistic. Like we're in a relationship. If I'm working with you and you're working with me, we're in a relationship.

SPEAKER_03 20:32

Which should be based on trust and um yeah.

SPEAKER_00 20:36

But of course, I'm gonna get active to think that I'll never get activated or triggered by my clients or that parts of my own unfinished business don't enter the therapeutic relationship.

SPEAKER_03 20:48

We're not robots, not yet. No. But therapy is still uh human-based.

SPEAKER_00 20:52

Uh yes. Hopefully, it's with the intention of centering the client's experience, of course. That's the hope. But what I've also found is as you work in deeper and deeper ways relationally, those lines get a little less clear, especially depending on the style of therapy that you're doing. If it a lot of it is hinged on process-based relationality. My experience of you is an important piece of the work that we're going to do together. And so I actually think it's very hard as a clinician to know when to include your own process in therapy and when to move it to the side at times, right? I think it's actually very tricky. And I think some clients who are very surf sophisticated at surviving really confusing complex relationships will elicit in us more activation.

SPEAKER_03 21:56

Yes, and especially from my experience now doing this podcast.

SPEAKER_00 22:00

speaking with so many specialists uh yes uh within that field yes almost everyone has trauma addiction or any any type of similar uh issues from from the past so yes they are affected themselves yes no one is just okay i've started it because i started to be a therapist or a doctor or a psychiatrist yeah whatever because um yeah my academic uh decision um most of them they decided to get into this in the first place to heal themselves probably and and second then to be there as uh as a service for others so that's why it's so difficult probably to hold that space and and be the the the the balanced person at every given time and i think i think the key there for me has been is just giving myself permission to be human and to have a level of awareness that I think a big mistake that I might have made early on is to again have fantasies of being able to perfectly meet the needs of my clients that's also been a great learning with my children the constant reminder that I will never perfectly meet their needs this good enough parenting mantra it's true also in therapy right it's good enough therapy you're not gonna perfectly meet the needs of your clients and it's actually in those moments of rupture there's an opportunity to take the relationship deeper because you learn something new about the person that you're working with when you know they're not met, when there's misalignment how you navigate misalignment um is a tremendous aspect of potential relational healing. We were talking about that yesterday in the workshop that we were doing we had the privilege of having participants from the MDMA assisted therapy trials their voices in the workshop which is extraordinary and the and so many of the moments that they spoke to were these moments where they saw the therapist capacity break down or their humanity come through in ways where they drop the frame. Yes and the tremendous impact of how that was navigated and when when that's brought forward as a therapist you've got a really interesting moment of opportunity to really lean into oh my gosh yeah that that was not what I would have wanted not what I would have desired but say more sometimes those moments are more impactful than any intervention that you fantasize about assisting someone is this piece of humanity.

SPEAKER_03 24:58

Yeah being authentic at the end yes yes because it can be it it can be difficult at times when when you as a therapist probably I can imagine um want to be authentic but you want also not to please the the you want to achieve results but you don't want to please but still hold uh certain boundaries uh and yeah in place so and the perception of the other of your patient yes might be okay it's not helpful.

SPEAKER_00 25:32

Yes. I mean it's so interesting yeah where I've landed with it is just leaning deeper and deeper into authenticity of relationality. And um I don't know I I've worked with the therapists at my treatment center around this although I I don't think I've had to share this with them because they innately a lot of them innately kind of knew this but we've talked about this idea of when you're working in therapy your voice should sound the same as when you're talking to a normal like a person outside of therapy. And some people will use a therapy voice their voice changes and they they all of a sudden are it's kind of true with yoga too like you'll have a yoga instructor that uses a yoga voice and immediately I'm like oh my God this person's performing and I cannot drop in if I hear them you know we're talking in the hallway and I say nice to meet you and we start and I go it's so nice to be here. It's like what's happening? It's the same thing with therapy. It's a very interesting thing how much do you allow your true kind of humanity to come into the space and in some ways it's subtle and maybe this sounds a bit extreme but I actually think putting on that persona even if it's the slightest bit a way of positioning yourself as being more sage or less human in some way. I see

Client Intuition and Heightened Awareness in Psychedelic States

SPEAKER_00 27:01

that yeah and that positioning yourself in that way ultimately you can't meet the client in the same way when you're always positioning yourself right and so there's great power in understanding that and when I started working on the trials oh my gosh the difference is when people are taking certain compounds like for example MDMA their radar for picking up on your bullshit is 10x in some ways and also their attunement to what mess what you're saying versus what you're embodying energetically. So my husband and I worked on these trials he's a clinical psychologist and a neuroscience researcher and we had to be we worked together in the trials as co-facilitators and we had to be like really mindful of like the dynamics that we had not entering into the room.

SPEAKER_01 28:01

Yes.

SPEAKER_00 28:01

Because I remember getting in a huge fight with him one morning before we had a session not like huge, huge but big enough that it was very troubling. And I wasn't working with him on that trial but I came in to to with my other co-facilitator with the participant and she looked me dead in the eyes about an hour into the session and said are you okay? And to have someone look and really want to know the answer like I almost started crying and not expected. Not expected but also how do I navigate that moment without gaslighting her out of her intuition of picking up on something with me. So those moments you really have to be aware of what you're bringing into the room because it gets amplified in those settings and you're with people for hours you know it's easier to kind of maybe compartmentalize or something if your session is 50 minutes long. When it's eight hours good luck to you like you things are going to start to break apart at the seams a little bit.

SPEAKER_03 29:11

And so how do you really navigate that respectfully and also from a very human perspective and know how to proceed and continue to do the work and and and not um you know I've seen therapy you know I think sometimes clients are picking up on things all the time and a classic therapeutic maneuver would be like I'm fine but why are you asking right it's like immediately like oh is there something about your process that needs attention instead of like well yeah I actually got an each five this morning which is you know or I'm okay thank you for asking I I feel really capable of being present with you but yeah I appreciate that you're picking up on something can you say more about that you know I I love communication and and this is a beautiful explanation how nuanced communication can be and that communication is very passive in some or often you know probably 80% is yeah is just gut feeling how someone is sitting how the energy as you explained it and only a small part is really what is being said.

SPEAKER_00 30:24

Yes I couldn't agree more. Yeah verbal versus nonverbal what is the felt sense of being with me how do you navigate in a session when maybe a a participant might ask you to do something that doesn't feel authentic for your process and yet it feels important for them. You know how do you set a boundary knowing that that might cause a rupture for someone and at the same time you know we need to be able to set boundaries we need to be able to keep people safe and they are on this compound that alters their their choices and there's in some instances a real freedom of disinhibition and how do I hold in mind that what how they're operating from now how would they feel tomorrow about something that happened here today when they return to you know consciousness that's a little bit more compacted.

SPEAKER_01 31:24

Yes.

SPEAKER_00 31:24

That's a really and at the same time wanting to honor their wisdom and their instincts and what's feeling right for them. You know so if a participant says like I want you to dance with me and you're not feeling it and you're like oh how do I still honor what's happening for you and recognize that I'm not in the same place and knowing that it might cause a rupture and it might make them feel ashamed for asking or I think it's yeah but in this case it's important to keep the certain boundaries and to be yeah and to be congruent with what feels right for my own process as well.

SPEAKER_03 32:10

You know I mean you you're obviously a therapist a senior therapist and um know how to deal with your

Training Clinical Teams to Hold Client Feedback Without Defensiveness

SPEAKER_03 32:18

your patients but how is it within a therapeutic environment where not everyone who's involved working with that patient can pick up all the little details and maybe sometimes a little word can yeah can create a big chaos. Yes yes have you experienced that and how do you deal with it?

SPEAKER_00 32:37

Yeah do you do training internally or how how do you prepare your team so I'm thinking about what that means in the context of let's say a clinical research environment where you're having other staff members who you know like a program coordinator or someone who's working with a participant who doesn't have the same level of training. Yeah I mean that those are those are sometimes the hardest because everything that happens with the study team when I'm a facilitator everything that happens with that team is my responsibility that's how I think about it. And so if it comes up in the session I have to lean in to be the person that holds responsibility so I don't join them in going, oh yeah, that's terrible you know like I need to lean in in responsibility and not I want to validate their experience. It's a tricky line right because this happens in our treatment center all the time right client is saying something that they don't like about what's happening in treatment or an interaction with another staff member is not feeling good to them. And I used I used to tell the staff your job in that moment is not to protect the program. And it's not your job to defend your colleague. Now you don't want to pile on and add to that in a way that feels duplicitous or kind of like adds to splitting but your job in that moment is to hear about their experience and that's a hard instinct for people because I think they they immediately feel like they want to hold rank but that client's experience is immediately undercut. And they what they say to themselves is like oh I you're not a safe person for me to talk about things that make you uncomfortable and that that has ripple effects through all of their treatment experience. So I'm very proud to say that you know our staff have been trained to to be curious in the face of hearing feedback that me it might be their best friend that works at the program.

SPEAKER_01 34:45

Yes.

SPEAKER_00 34:46

And how do you hold that really thoughtfully with curiosity compassionately without colluding in a way that feels like splitting or dangerous for the for the program's kind of integrity that's a really tricky line. Yeah yeah and I think that's something that we need to be prepared to talk about and and to make to create enough safety in the staffing environment that people can bring it there. Yeah because trying to say over and over again again to my staff and also to myself like a client bringing up something that they don't like or an encounter that didn't feel good to them that in many ways is a success for us. It means that we're safe enough for them to bring those things forward. Now we have a real opportunity to decide what we're gonna do with this and what's our contribution and how because how many people go through treatment performing I mean I'm sure you can appreciate that yeah they know the drill they know how to please everyone right I I always say you know if the part of if they're lovely and delightful and so well behaved the entire time they're in treatment, we haven't actually helped them.

From "Resistant" to Protected: Reframing Client Behavior

SPEAKER_00 35:59

Janina Fisher's got this great quote about that, right? Like, you know, we have to encounter the parts that are unlovable the parts that we hate the heart the parts that um intimidate us if we haven't created enough safety for that layer of the person's experience to be present in many ways I feel like we haven't done treatment.

SPEAKER_03 36:19

Yes.

SPEAKER_00 36:20

You know, in certain milieus the staff can get really worn down because people are kind of manifesting you know I know you like this version of me but are you gonna are you going to be able to handle this version of me? And can you handle my despair and my rejection of you and stay present and steady in the face of that and recognize that um this is deeply connected to my woundedness. And that's where I think the staff do need a lot of support and I think sometimes we've done a great job with that and sometimes I've missed it.

SPEAKER_03 36:54

Every client is also different. Yes I assume um but so I understand your staff is trained to um validate the feelings of of your clients yeah and then you would you bring it up and process it also within a therapeutic uh setting yeah yeah and there's some lines where you know clients at different stages of healing you know they can move into aspects of themselves that are very scary and intimidating.

SPEAKER_00 37:25

And so when it goes really well the opportunity is that we can come back together therapeutically and once we've had a sense to understand what activated that that you know the therapist can sit with the client and say is it okay if I share my experience of you and what it's like to be in relationship with you. Not from a place of shaming but to say like you're actually really scary when you move into that. And I don't know if that's what your intention is but I just want to let you know it's very hard to speak. And what is that like for you to hear I mean the gift of giving back real relationship to people because you know it's happening out there. You know that that's going to reenact itself in different ways. And for many people as they move closer towards intimacy it feels more and more threatening you know the closer the relationship gets the more it needs to activate certain parts of the system that will attack because of fear or different reasons. And so how do we work compassionately with those aspects of self as well?

A 13-Year Journey Into Psychedelic Research, Starting With Psilocybin

SPEAKER_03 38:38

What type of clients have you been working with which led you to start experimenting with psychedelics yeah so I've been working um on the clinical trials with psychedelics for the last 13 years at University Wisconsin Madison and I started working with psilocybin.

SPEAKER_00 39:00

So the very first study that I was involved in was a high dose pharmacokinetic study on the safety of psilocybin for normals is what they called, which is like hilarious because I don't think anyone's for normals? Yeah meaning people without diagnoses. Okay. Yeah I know you're like what is a normal um yeah so um I didn't start serving as the uh clinical director at my program until about 10 years ago. So I prior to that I was working in community health as a be uh fully integrated behavioral health consultant. I did that for eight years in Madison after I got my doctorate which I love that work that work was great. But I it was more population based care. So it wasn't about going really deep with people it was trying to take care of as many people as we possibly could within the setting of a primary care clinic. And that work is really important but we had talked before about how depth work is what really speaks to me. And so I had the opportunity so my first exposure was through psilocybin because I again no prior psychedelic experience wasn't exactly sure what would come up for people and working on that trial was really mind expanding for me because I saw people move so deeply into parts of their psyche that again I think there's some traditions that work with that idea the unconscious right in terms of psychoanalytic approaches. So I I immediately got it I mean I got that there was something very powerful there. But I think in the beginning when I worked with psilocybin I I thought oh this is basically psilocybin is a facilitator of exposure therapy. It's like whatever the thing you're most afraid of or the thing that potentially is the scariest I think that was somewhat informed too by the early research that happened with end of life and many client participants in the end of life trial with psilocybin, which was done I believe at Johns Hopkins and and also might have been at NYU. The end of life studies were people who had been diagnosed with a terminal illness and they were so filled with anxiety because they couldn't just like enjoy the rest of the time they had the meds that we had available were really not reaching them but there was so much fixation on dying and the idea of dying that it just riddled them with anxiety and distress. And many of those participants as I understand it experienced some form of death in their sessions. So you move towards the thing that you're most terrified of and it wasn't necessarily what they predicted it would feel like and because these compounds are disorienting and ego death is something that can happen for some people through ego dissolution, I thought, oh well this is just about exposure work. And then I had the opportunity to work on the MDMA assisted therapy trials between the psilo the start of the psilocybin trial and the start of the MDMA assisted therapy trials is when I started being the clinical director for the rehab.

SPEAKER_01 42:07

Okay.

SPEAKER_00 42:08

And I did not talk about my clinical research with psychedelics with my boss in the beginning because I thought well maybe this is a one-off thing. I don't know what's going to happen with this. But I was um all the while while I was in the treatment center I was thinking about the opportunity or the the the the opportunity that could be presented for people to have access to something like this. And so then I started working on the MD I got trained for the MDMA trials while I was still in that role at the rehab and I thought I don't know if anything will ever come of I mean I can't imagine doing MDMA assisted therapy with people. And then they were saying oh your site is active you're good to go so then I turned to my boss and I said look I do psychedelic research there's a trial an MDMA assisted therapy trial I had no idea what was going to happen on the trial. I didn't want to kind of besmirch the reputation of the rehab like what if something crazy happened on the clinical trial and they're like clinical director of this treatment facility you know something goes badly right and he to I really appreciate how open he was and I said look this is really important to me I want to continue to do this work but I'd like to be able to protect some time to stay involved in clinical research with the psychedelics and I think there's a there could be a real opportunity for us to integrate something like this much further down the road. And he said I trust you and it doesn't surprise he said something to me like I'm not surprised that you would want to keep learning in a different way or that you would want more than just this. And so he was supportive and as I worked on the MDMA assisted therapy trials my work on those trials started influencing my work in the treatment center because the way I was trained to work on the MDMA assisted therapy trials was it was a completely non pathologizing model. And it was about this idea that clients have innate healing capacity. And in many ways, the systems that we've built for care have led them to feeling more sick. And when they're not being met in those systems, they blame themselves. And I started to finally like the light bulb went off for me around somatic work and how we need to be working with our clients somatically. And um this idea of really clients, uh clinicians operating from more of a place of humility, we remove the word resistance from our treatment center. Like we stopped using the term resistance and we started talking about protection. That if a client is unreachable, to not conceptualize that as resistance, but we are not safe enough to allow them to drop a certain form of protection. And that's a very different way to orient when you're working with a substance use population. Is you know, the language we use can be so carries a lot of judgment. Even the idea of a defense treatment resistant, it's like this client has resisted the good treatment that's been given to them, as opposed to saying, oh, they haven't been reached somehow.

SPEAKER_03 45:17

Yeah, not yet.

SPEAKER_00 45:19

Yet, exactly. And so I do think the work that I did in the trial started deeply influencing the mindset and the ideology. We started doing breath work in our treatment center because I saw how powerful non-ordinary state work with or without compounds could be. And um, I brought in a somatic experiencing practitioner that I found early on, who's an absolute wizard with clients and so powerful in working with people's bodies.

Bringing Ketamine-Assisted Psychotherapy Into Residential Treatment

SPEAKER_00 45:47

And then about six years, I in 2019 I got trained in ketamine-assisted psychotherapy. And um, I went back to my our CEO and I said, look, ketamine is available now. It's gonna be a while for MDMA, it's gonna be a while for psilocybin, but I think we could do it here safely if we do it in the right way. And so six years ago, we started working with our clients with ketamine-assisted psychotherapy in the residential setting, which felt like a very, I was very nervous about it. But, you know, in many ways, and I'm sure you can appreciate this, the existing healthcare system and the way that we navigate substance use disorders is has a lot of room for improvement. The relapse rates for people are so high leaving treatment. I don't think we can afford not to continue to be innovative in some way. If we can, if we can save, you know, two or three more people a year, we can reach two or I don't think save is the right way to say it, if we can reach them. Yeah. Um it's kind of our responsibility to keep innovating in some way and to find what I the way that I conceptualize the way we use ketamine assisted psychotherapy in our treatment center is it is a way to resource people from the inside. Because the thing that kept coming up for me over and over again is even when clients are incredibly motivated, when they want to get better, there are still parts of their system that will fight, that will block, that will dissociate. And sometimes we just don't have enough time with people, right? And a long-term commitment to the to residential is very costly and um it's not possible for a lot of people. I mean, that's a whole other issue, the access issue I won't get into in this moment. But if we could help people feel safe enough inside, and that is the other thing that I learned that when people can't go to these really difficult places, it's not because they're not brave enough or courageous enough, they don't want it badly enough. There's not enough safety inside to feel resourced enough to move towards the difficult thing. And in the right setting environment, these compounds can provide resourcing in a way that's incredibly powerful.

SPEAKER_03 48:09

You mainly work with like clients with addiction um symptoms?

SPEAKER_00 48:14

I do a lot of different things. So I work at the university in clinical trial research. We have an outpatient practice called Inagrata, which is a ketamine-assisted psychotherapy practice where people will come and do intensives or do outpatient ketamine-assisted psychotherapy work. Then I'm the clinical director at the manor. And one arm of what Inaugrata does is they were actually co-located at the manors so that we can do ketamine-assisted psychotherapy with clients in residential treatment. So there's a lot of different pathways through which it might happen. And then I'm involved in different things in clinical trial research and teaching and that sort of thing around psychedelics and psychedelic education. But so there's a subset of clients that will come through our treatment program, which is a trauma reprocessing program. It's a substance use disorder clinic, but it's really a trauma reprocessing program. And so if certain clients are successfully navigating the stages of trauma reprocessing work, and a big part of that is undissociating, learning how to feel their feelings, having enough relational safety, coming into the full reality of what's happened in the wake of their substance use and the impact on themselves and their family. We start to understand how trauma has impacted that. We start to do trauma work in the form of often EMDR and somatic experiencing. We have an embodiment coach that works with people at a body-based level. And also the groups that we do, there's definitely some influence of internal family systems work as well. And then if that client is kind of proceeding with some depth in that work, then we think about adding ketamine-assisted psychotherapy as a trauma reprocessing tool. So not everybody does it.

SPEAKER_03 49:59

It's selective.

SPEAKER_00 50:00

Yes. So the team collectively decides if some if they feel like someone is open to it.

Inside the Ketamine-Assisted Psychotherapy Process

SPEAKER_03 50:05

Can you guide me uh through the process? How would you decide when how to use it and how are the procedures, how many times it's been used, and what happens exactly within that person?

SPEAKER_00 50:18

Yeah, absolutely. So um it's a little bit about what I talked about yesterday. Um, it's not maybe what people would think. Like I think some people think like, oh, use psychedelics if nothing else is working. And I don't think about it that way in this setting. I think about things are working, things are starting to deepen, but there's still some parts that are really difficult to access. So for a client, let's say that isn't done enough of the work on the front end to be able to do something like EMDR, for example, I would never think about them for cap. Because if they can't begin to engage in that process of deepening, more safely feeling a fuller range of emotions, building enough therapeutic trust with their therapist. You know, there's some clients who come in who, for a collection of reasons, we we are not in alignment the entire time they're in our process. And that could include them us saying, look, we really want you to be here for a certain amount of time, and them saying, I'm not prepared to do that. It could include folks who we talk about a more robust continuing care plan. They say, Thank you, but no, thank you. I'm gonna go ahead and try it on my own.

SPEAKER_01 51:35

Yeah.

SPEAKER_00 51:35

So those are never clients that we would work with with CAP because we're not using ketamine to pry open something that's pretty shut.

SPEAKER_03 51:44

Yeah.

SPEAKER_00 51:45

Because that to me feels it's a little bit, it's to me, it feels like you're exploiting your access to create an opening that doesn't exist. For us, it's like if the opening is there and someone wants help deepening the opening, okay, that's when CAP is really powerful.

SPEAKER_03 52:04

There is already a positive direction to support that.

SPEAKER_00 52:09

100%. And we've agreed on the continuing care plan. There's a desire for abstinence in, you know, post-discharge. Everyone that's gonna be working with them following treatment is supportive because I can't do CAP with someone in treatment, send them to a sober living environment. And everyone says, Oh, well, you relapsed in treatment. That's not gonna work, right? So, a big part of that process over the years was also reaching out to all our referral networks and certain programs. And I think it's changing. I think people are much more open and receptive to this idea of alternative treatments. So let's just say I we, you know, working with a client that has made good progress, but maybe there's just still a hook of self-loathing that we're just having a hard time getting relief from, or maybe they've gone very far, but the depth of the grief that they have is still kind of tightly wound. Um, what we've noticed in the relational dosing protocol that we use, it's, you know, so if someone is selected, then we specifically prep them for the ketamine assisted psychotherapy, the subjective effects of the drug, what they would expect. I have some podcasts that I've made on this topic just for our clients to listen to. So they listen to the podcast, learn more about our approach. We are not trying to pull people out of their bodies. Let's say if you go to a ketamine infusion clinic, you're trying to target a certain dissociative range, which in many ways lifts people out of themselves to some extent into kind of a therapeutic dissociation, is what they would call it, or a ketamine dissociation. And there's good research on the level of dissociating, be dissociation being associated with depressive depressive symptom improvement. But we're not just using it for depressive symptom improvement. We're using it so people can more safely explore what's present inside themselves. And so as they go into that, they take the medicine at the beginning of the session. The two therapists that have been working with them the most deeply are present in that session. We have the luxury of being able to have two people there. That's an accountability piece. It's being able to create safety and the depth of the relationship being really held. The clients will take the ketamine, put on eye shades often, lay down. We have a playlist that we've built specifically for this person. Lozenge or rapidly dissolving tablets.

SPEAKER_03 54:29

Okay.

SPEAKER_00 54:29

And then they go inside, they hold that in their mouth for a period of time while they're swishing that medicine around. It can be anywhere up to 20 minutes. They're not talking, and the ketamine is slowly coming on board. And many, for many clients, the first signature of that medicine is actually anxiolytic. So it creates a sense of relaxation in many clients or heaviness, or for some people, it feels like lightness. And then after they spit out the medicine at around 20 minutes, music is playing the whole time. The therapists are holding space for them. Where that person goes inside in that session is entirely driven by the client. Yeah. It's not the therapist dictating it.

SPEAKER_03 55:05

So there is always a therapist. Two therapists. Two therapists. In the room. Psychotherapists.

SPEAKER_00 55:10

Yes. That they've been work, they've already been working with for maybe four weeks, five weeks, six weeks. And then, but they're there to kind of as a relational tether so that if someone says, Oh, I'm feeling really stuck, or feel like nothing's happening, or I'm not sure what to do, or I feel something coming and I don't want to feel it, they're there to validate, normalize, reassure, witness, and intervene when someone needs help. And that's kind of their role in holding that container. And I have to tell you, it'll make me a little emotional. The depth of the work that these clients do when they're given the container to do it with the help of this medicine is awe-inspiring. And they move towards really painful things. But they feel resourced enough inside and they feel like the container is safe enough to do so. And it's very powerful. And it, you know, it challenges a lot of the beliefs that we have about folks in early recovery. They'll always choose the easier path. You can't give them a substance that would feel good because then it's going to immediately enact a cycle of use. It really brings up this idea that if you're given really good support and understanding how to choose the path of working more deeply, that they choose it over and over again. And it's extraordinary.

Witnessing Deep Healing in Psychedelic-Assisted Sessions

SPEAKER_03 56:45

Why is this making you so emotional?

SPEAKER_00 56:49

I mean, if you could see the transcripts of what these people touch into, I I mean it's to see people being able to be led by their own process that they've been given enough support to tune in to listen to themselves and to safely feel and choose to feel deeply around pain that it leads to their own healing, it's extraordinary.

SPEAKER_03 57:16

Yeah. That's that's the goal of every therapeutic therapeutic environment.

SPEAKER_00 57:23

That's exactly right. So the privilege of bearing witness to that and having the privilege and the opportunity and the administrative support and a CEO that said that's not a crazy idea, and to do it in an environment where that's very, you know, it's avant-garde, it's edgy. Um to give people relief in in that way, to trust themselves in that way. It's very powerful. It's a real privilege.

SPEAKER_03 57:53

How many clients have you have you been uh treating uh with ketamine so far?

SPEAKER_00 57:58

Gosh, that's a really good question. I don't know if I have an accurate number, but it's been six years. Yes. And I would say in each cohort, because we have a max of 11 in our program, you know, we'll have some co cohorts where three or four of the clients are doing it, we'll have some cohorts where no one does it, we'll have some cohorts where two people do it.

SPEAKER_02 58:17

Okay.

SPEAKER_00 58:17

I mean, it's gotta be at least, I would say 70 people by now, could be close to 100. Yeah, I don't know for sure. And then we follow them, you know, we follow up with them later. And what have you said about your experience? Because in the beginning, I was so nervous that I would follow a client and they'd be like, Oh, is that one moment with ketamine? And I just went and started abusing ketamine, what I left treating, you know, I was really nervous about that. But you know, it what's also very powerful is this urge comes up when they're in the presence of the ketamine, where they feel relief and they feel good, and they immediately panic and they think, Oh, I relapsed, or I'm getting high. And in that moment, you can say to them, Okay, what do you notice? And they'll say, Well, I feel really good. And they'll say, How does this feel different than getting high? And they almost universally will say, I feel more connected to myself than I've ever felt. Yeah. Whereas when they were using, it's about escaping self. And I feel connected to you. You know, that's that very common thing, right? I mean, even people who don't have use disorders, you get to a party and you meet up with a friend and they've been there before you, they've had a couple glasses of wine and you're like, oh, you're in a different spot that I'm in, right? So it's like they feel more deeply connected to themselves and also to tolerate and receive connection from someone else. And in that way, they're able to unblend this concept of relief and pleasure from just being about getting high and recoding it as part of a healing trajectory. So that's very powerful and being able to know that they can make that choice.

SPEAKER_03 59:57

Have you have you been collecting data over what's the same? We collect data.

SPEAKER_00 1:00:01

Yes, we have been collecting data, but we have not analyzed it. And it's because re doing research in a clinic like in a clinical setting is really tricky. I know. Yeah, it's very difficult. And but we are collecting it. We're collecting it, we're collecting it. A lot of it has been more um qualitative than doing anything quantitatively at this point. And it's so hard to know, right? Because we don't have, we don't, we can't compare them to folks who aren't doing it in a in a way that makes sense. But but we've been following, we fought, we stay in contact with all of our alumni, so we get a chance to learn about them. I want to launch a new project more recently in the in the coming year just to understand more about how they navigated and access treatment. And some clients will come back and do an intensive with us. And um, but what we've learned so far has been very positive. And, you know, of course, we can't get a hold of everybody, so it's possible that someone didn't have a positive experience. But when you when you're able to do that work, and then the therapy that follows it is that much deeper. I mean, it's it's gives you a lot of good information about what's happening. Yeah.

SPEAKER_03 1:01:06

So majority is a positive experience at what what what you're saying.

SPEAKER_00 1:01:11

Yeah, I will say that there one or two times I think we were like, maybe we shouldn't have done it with a person. And I think that's more they hadn't done enough quite enough of the depth. And I think in those instances, people they just feel like they stay more superficial in it, or they're like they rapidly come to a conclusion, like, I've forgiven my husband for everything. And I'm like, that feels pretty quick. It's like four minutes in, like, there's no way. So I've seen that a couple of times where we're like, oh yeah, I can see why maybe we shouldn't have with a certain client, but none of it has resulted in deleterious outcomes that we've been able to track. Um, it's been extraordinarily successful. Um, I was so worried when we started doing it that all the clients would like mutiny and be like, I'm leaving if you don't do cap, or it would have. But then when the clients see a client do it, it's like watching them walk out of an EMDR session. And and what I kind of love is clients going, I think I want to do it, but I'm also really scared to do it, like because I don't know what's gonna come up.

SPEAKER_01 1:02:17

Yes.

SPEAKER_00 1:02:18

And that's like, oh, yes, we can support you with that. But someone coming in who's like, I want to do ketamine from day one, they almost never end up doing it.

SPEAKER_03 1:02:27

Yeah, yeah. Because there are also clinics who offer purely ketamine therapy. And then um, often I hear like, uh, I've done this amount of uh sessions and it didn't help. Yeah. So what are they missing out here?

SPEAKER_00 1:02:40

Oh, well, they're not doing therapy most of the time. They're not using it as a facilitative tool to deepen therapeutic process, they're just relying on the drug. Yes. And I have to be honest, I don't love ketamine as a drug. I think it's a weird drug. Like when you're just pure ketamine, my whole thing is ketamine needs relationship and it needs heart. And without those things, I have no interest in that drug. I mean, I'm glad it exists. You know, it's on the list of essential medicines for the World Health Organization. Yes. It's used to sedate children in emergency rooms. It's an extraordinary drug. But the subjective effects I do not love.

SPEAKER_01 1:03:16

Yes.

SPEAKER_00 1:03:16

But the lower dose range, I think that's a big part of it, is where we dose people into, they're they're connected to themselves, they're more embodied, they can feel more. Whereas if you dose them into the infusion-level dosing, they they often will say depersonalized, strange, weird, bizarre, numb. I have no interest in those subjective effects.

SPEAKER_03 1:03:36

Yeah.

The Future of Psilocybin and MDMA in Addiction Treatment

SPEAKER_03 1:03:37

Yeah. So like in the mid-range. Yeah.

SPEAKER_00 1:03:39

Yeah.

SPEAKER_03 1:03:40

Are there any other psychedelics which are promising you would implement if it would be legally in the US?

SPEAKER_00 1:03:48

Yes. I'm very excited to get to the point where we can work with psilocybin. Yeah. The substance use disorder research that's been done around psilocybin is extraordinary. It's one of the few psychedelics that has anti-addictive properties. You can't build a tolerance to psilocybin. To be able to safely use that would be extraordinary. I mean, I've worked on an opiate use disorder study with psilocybin. I've worked on a methamphetamine use disorder study with psilocybin. It was extraordinary the work that we saw happen with those people. The alcohol use disorder studies have been robust. There, there, there's still time for a phase three launch on that. Um, and MDMA assisted therapy. I I really would be very excited when we can use that compound in the right set and setting. And I think residential is an amazing place to do that work because you know, on the trials, everybody was outpatient. And, you know, it's destabilizing. Yes. So to have a residential container, it's important. Yeah, but also so important that people are trained well, they understand these nuances. Um, because you you need really thoughtful facilitation.

SPEAKER_03 1:04:58

And would you would you based on on a client decide if let's say assume uh psilocybin, md mdma, uh and and ketamine, yeah, uh all is legal. Would you when would you decide which one to to use with with the patient?

SPEAKER_00 1:05:14

Yeah, I knew you were gonna ask that. I don't know. I mean, I think it's hard to distill it down in that way. Yeah, I used to think I was just using ketamine until other things became available, but I actually love ketamine, it's very gentle. So in many ways, I think almost everybody would have start with ketamine and then um I mean, if if I have if I'm compelled, you know, psilocybin is more existential. It's like big questions about life, meaning, purpose, universe, death. Um, that it has more of that quality to it. Whereas MDMA really is there's so much relationality in it, the way that clients engage with you. You know, sometimes in the trials when people do psilocybin, they put on the eye shades and the headphones and they just they disappear from you. Whereas in the MDMA trials, they were like, Okay. Yeah, you are you are critically part of it. It took a lot to get people to go inside with MDMA because there's so much relationality and obviously the chemical structure of it, it's serotinergic and it's oxytocin that's being released. And so, um, and it's activating. Whereas ketamine, I think for many people, it kind of feels it's harder to talk on ketamine, and so gives this opportunity to work with felt sense and nonverbal processing in a different way. Um, but I think I'm really excited and I'm also very cautious about who will be using these compounds.

SPEAKER_03 1:06:48

Yeah, if I think also from a risk perspective, if someone likes uh more psychiatric cases, uh get get hold of such services without proper assessments, uh it can be yes, can be having uh negative effects.

SPEAKER_00 1:07:03

Yeah, that's why I think residential is gonna be an extraordinary opportunity. But again, now we have a different kind of challenge because some people can have the opportunity to financially do residential treatment and they can't. The access issue of the reimbursement, though, that's a very complicated area that's still gonna need a lot more attention.

SPEAKER_03 1:07:21

How long do you think uh will it take for Asilo Cybin and MDMA to get their approved?

SPEAKER_00 1:07:31

Um, I have no idea exactly, but if you look at the news on it, and you know, President Trump just signed in an executive order that included two different sponsors that are working with psilocybin to fast track the review of their new drug application. Okay. And Compass um is working with treatment-resistant depression and USona Institute that I work with USona Institute. They're based actually near Madison. Um, that was major depressive disorder, and they're getting close to wrapping up their trial data. Compass has already finished their trial data. So um, and then the other voucher was submitted for methylone, which was kind of a surprise for many people. Um, Resilient is the company that's working with MDMA, and they're in a process of determining what resubmission will look like for them because MD MDMA was not approved.

SPEAKER_02 1:08:30

Yeah.

SPEAKER_00 1:08:31

Um, so I think in the coming years here, we're gonna see some big shifts. And it's exciting. Let's see. And I also have a lot of concerns about how it gets rolled out, depending on where it gets rolled out and who's trained and equipped to do this work.

SPEAKER_03 1:08:50

Probably to start with a residential setting, I agree with you. It would be amazing. The best, the best thing to start with. Because I'm also very skeptical about outpatient programs. Yeah. Um it's it can yeah, you cannot hold the container of what's happening. And uh I'm interested, what have you tried for the psychedelics?

Dr. Thomas's Own Healing With MDMA and Ketamine

SPEAKER_00 1:09:14

Well, I was I have had the privilege of being able to um become a trial participant in the MDMA assisted therapy. Because they're the therapists that worked on that trial, there was a separate FDA study where they gave us the opportunity to have an experience with MDMA, being facilitated with MDMA assisted therapy. And I will say that we have to stop thinking that like one dose is gonna magically fix anything because I that's not how it works. But um, I felt truly seen in a way that I'd never experienced in therapy before. That was very powerful for me. And it wasn't actually during the MDMA session, it was during the integration that followed. And that was a galvanizing moment for me about this concept of what does it mean to really witness people and to the experience of being truly seen in therapeutic process. And I realized up until that point I had never felt truly seen in therapy. Okay. That was very powerful for me. And that was a big awakening in terms of how often there's a performance layer that exists between therapist and client, and they don't actually have that experience of feeling fully seen. I've also had um the privilege to work with ketamine in a low dose capacity with my therapist. Um and it's a longer story, but it what ketamine was able to do for me was help me get a felt sense of how much trauma was still energetically stored in my body in a way that I remember the feeling. You know, I grew up with a pretty strong religious background, but I had a lot of fear around God. The way that God was talked about sounded terrifying to me, not loving. And I was afraid of possession as a child all the time because I'd been told if you leave your mind open, it's an invitation. So I used to get this feeling that would start in the bottom of my feet and run up my legs. It felt like terror inside my legs. And it was always associated with this fear of falling asleep. And what if something happens to me? What if possession happens to me? I'd gotten pretty distant from it, but one of my first lower dose ketamine sessions, I felt it with tremendous intensity. And I was like, oh my God, I remember this feeling. That was it. That was the whole session was feeling that intensity. It's not like I had this big insight about a connection, or but the embodied experience of what it felt like to be a child and have that kind of terror said two very profound things for me. It was real.

SPEAKER_01 1:12:03

You felt it before.

SPEAKER_00 1:12:05

I had felt it before. And it was still in me in some way. And those things were incredibly powerful because it's so easy to minimize. Was it really that bad? I don't know what it really felt like. But it it helped me really take care of the parts of me that still knew there was a tremendous amount of fear in my system. And that was a real trauma for me. That felt sense of that, what I navigated with that, where I felt like I had no help with that. Um, that was very powerful. And it was a big, like, oh, I see how this works. Ketamine's more abstract than some of the other compounds. And so it's a little bit more, I call it the abstract art of the psychedelic world in some ways. It does require connecting dots in a different way.

SPEAKER_03 1:12:55

You need to make interpretation to it.

SPEAKER_00 1:12:57

Yeah, but it's very interesting. It's like you, you the way you interpret is not here quickly, it's like you stay with the feeling long enough and the answer comes. You feel into the insight, you don't think your way there with cat with ketamine, which I think is incredibly valuable. So yeah.

SPEAKER_03 1:13:13

Um you speak out of experience and out of results. Um, thank you for sharing that story.

SPEAKER_01 1:13:19

Yeah, thank

Life Outside the Clinic: Balance, Movement, and Music

SPEAKER_01 1:13:20

you.

SPEAKER_03 1:13:20

What do you do outside the psychedelic field uh to stay in balance and in your life?

SPEAKER_00 1:13:28

I I am very grateful for my Peloton. My Peloton is gets a lot of use. I do a lot of my staffings because I I am virtual for some of them with my laptop in the bars of the Peloton and I'm pedaling. Um, I love snowboarding. Okay, I love it, makes me so happy. Uh, I'm in a band.

SPEAKER_03 1:13:54

Wow. Um what's your role?

SPEAKER_00 1:13:58

I sing. You sing, yeah.

SPEAKER_03 1:14:00

Okay.

SPEAKER_00 1:14:01

And um I have two children. I don't think that that keeps you in balance, but it certainly helps you understand the world is much larger than you know, my fantasies about who I am as a clinician. And gosh, I love movies. I love good TV. Give me a great series television show that I can binge watch the whole weekend. That never happens because of my kids, but I'm just like in heaven. Really, because I actually think media is like a very powerful tool therapeutically. And really now we live in an era where there's so many good shows. I love that. I love to eat good food. Love food. Yeah.

SPEAKER_03 1:14:45

That's a good balanced.

SPEAKER_00 1:14:46

I think so. I don't know that it is.

SPEAKER_03 1:14:49

I believe your children are part of the balance.

SPEAKER_00 1:14:53

Well, yeah. I mean, they thank God on so many levels, right? Um, because you know, I think I could easily just throw myself only into work. And it's yeah, they're my greatest teachers without question.

SPEAKER_03 1:15:08

I agree.

SPEAKER_00 1:15:09

Greatest teachers, yeah.

Closing Wisdom: Don't Be Afraid of Your Feelings

SPEAKER_03 1:15:11

If you think about everyone in the world, you could share a wisdom, something, a recommendation for to improve their lives. What would that be?

SPEAKER_00 1:15:21

Don't be afraid of your feelings. They're there to help you. It's your deepest source of wisdom, are your emotions.

SPEAKER_03 1:15:30

Chantel, thank you very much for being here today. Thank you also for for the work you do with uh psychedelics, pioneering uh the field also and advocating for uh for it um and so many conferences uh you visit, you have a busy life. Yeah, but I'm I'm pretty sure you you you you manage to stay in balance uh from what I can see. Thank you very much for your time.

SPEAKER_00 1:15:55

It's really lovely to be with you. Thanks for having me.