Breaking Free from Narcissistic Abuse

Could This Be Right for You? New Help and Hope for Narcissistic Abuse Survivors

• Kerry McAvoy, Ph.D. • Season 3 • Episode 94

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Narcissistic abuse often leaves devastating consequences to the survivor’s confidence and self-esteem.

Today, Kristin Arden, DNP, APRN, PMHNP-BC, Mindbloom’s Clinical Director, and Shari Botwin, LCSW, trauma counselor, join me to discuss the use of ketamine therapy as a new alternate treatment option for trauma survivors.

If you would like to learn more about Mindbloom or ketamine therapy, please see https://mindbloom.com/kerrym100. To take advantage of the $100 off total of your first two treatments, use discount code “kerrym100.”

Did you know the brain is malleable and open to change? It’s called neuroplasticity. In this week’s exclusive Podcast Extra interview, Kristin and Shari discuss how to best capitalize on our brain’s openness to change. Get immediate access to this interview when you subscribe to the weekly newsletter.
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Kerry Kerr McAvoy, Ph.D., a mental health specialist and author, is an expert on cultivating healthy relationships, deconstructing narcissism, and understanding various other mental health-related issues. Her memoir, Love You More: The Harrowing Tale of Lies, Sex Addiction, & Double Cross, gives an uncensored glimpse into the dynamics of narcissistic abuse.

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Ep. 94 Final Sequence

Kerry: [00:00:00] 75 percent of victims who leave a narcissistically abusive relationship suffer with PTSD symptoms. Today, Kristin Arden and Shari Botwin from Mindbloom joined me to talk about the possible role ketamine could have to help you heal from your abuse.

So, today we're going to do something different. We're

I am taking kind of a different tact and having two people on that I'm very excited to meet to talk about different types of treatments. I'd like to introduce you to Kristin Arden, who is a clinical director, as well as Shari Botwin, who is the trauma counselor, who is ahead of the PTSD track. Both of them are at Mindbloom.

So we're going to talk about Mindbloom's treatment options for PTSD, how that connects to narcissistic abuse. And what it might mean if you're someone who's struggling with your treatment options and really recovering from Your your experiences that you've had in a toxic or abusive relationship. Kristin and [00:01:00] Shari, Thank you so much for being here with me Why don't you tell us a little bit more about yourself what you do and how you got into doing what you do 

Kristin Arden: I guess i'll go first a little bit about myself I'm a psychiatric nurse practitioner and I have a doctor of nursing practice. I've I've worked in mental health for over 20 years.

Half of my career in the state hospital system in California in inpatient psychiatry, and then the second half of my career in outpatient mental health and focus on innovations in the mental health space to increase access to safe and effective mental health treatment options. So I've been with Mindbloom for the last five years.

I was the first clinician at Mindbloom, and I work as a clinical director at Mindbloom, so through that had a key role in the development of our clinical protocols, treated over a thousand individuals with ketamine therapy, or have supported over a thousand individuals through their journey with ketamine therapy.

And on a day by day basis, I maintain a caseload of clients who I support through private practice and I oversee all of our clinical services [00:02:00] at Mindbloom. 

Kerry: That's really cool. How about you, Shari? How did you get involved with Mindbloom? 

Shari Botwin: So I've been doing trauma therapy and private practice for 28 years.

I also have written a couple books and the focus of my work, especially in the last 10 to 15 years, has really been working with adult survivors of all different types of childhood abuse. Mindbloom reached out to me and said that they were going to develop a ketamine track specifically for post traumatic stress disorder.

And, you know, I was very excited about that. The opportunity to implement some of the things that I've learned clinically in terms of helping people better understand PTSD and how utilizing ketamine therapy is a alternative or additional support that people can use when they're going through the healing process.

Kerry: Let's describe what happens with PTSD and why ketamine might be an effective option. I remember back in the day, I think it was like roughly 15 years ago, that they were starting to [00:03:00] use a beta blockers when working with vets while vets recalled troubled memories and noticing that there was an improvement with a faster recovery.

So help me understand how this idea came about and why it should be considered as part of someone's. possible treatment regimen. 

Shari Botwin: Do you have like a day? Well, it's the timing of this is really great because when I joined forces with Mindbloom and helped them to create the track, the PTSD track, I had not ever had any clients doing the program.

Since developing the program, I actually am currently working with a client who I've been treating for 13 years, she has childhood trauma and it's different types of abuse and one of the things that she did deal with was living with a very narcissistic mom who I would say was abusive verbally and through the last 13 years there's been things that she has really struggled with around the flight or fight response, [00:04:00] the excessive worrying about people being mad at her, the feeling like if I do something wrong, people are going to.

hurt me or they're going to go away from me. So it's actually amazing because she's done five or six ketamine treatments. And what happened after the third treatment was she started to have like this openness about really going back to early childhood and trying to figure out what is that feeling that I get when I am in a relationship with someone and I'm worried about what they're thinking or we're fighting.

And then I go into this really dark despondent. Suicidal place. So she actually started talking to me just a couple of weeks ago about her relationship with her mom and how one of the things her mom did when she was very, very young is she would leave my client in the home alone when she was like five or six years old, tending to her other daughter, but also choosing to go to church.

Instead of stay home with her daughter So she actually started exploring the pain behind that form of [00:05:00] abandonment and how when her mom would come back Like when her mom would be in the home. There were times when her mom would berate her shame her Say things to her that at those times in her life made her feel unlovable unwanted Uncared about.

So she's finally now 13 years into therapy, actually exploring what she felt at four or five and six. And now she's figuring out how she can almost, like, heal that part of her and recognize this shouldn't have happened. This wasn't my fault. What the ketamine is doing, I think, is it's allowing her to go to that place without going into despondency and shame.

She's not suicidal right now as she talks about it, and she's obviously very, very emotional. It's gut wrenching, but I think what the ketamine is doing is it's making it a tiny bit more palpitable or manageable so she can actually feel those feelings, talk about those feelings, and then move through it.

Kerry: Yeah, [00:06:00] Kristin, one of the things that you and I have similar is that we both have been in a psychiatric facility. It sounds like you were at a state level. In other words, for those who don't understand what that means is that's when somebody has failed out every other treatment option, and it's the most restrictive treatment protocol.

We really try to protect people's rights. So we start out with. Of course, you come into the office and you get treated with medication or therapy. And then when those treatments fail, you progress to increasingly safer environments for this person's safety to protect them. So in other words, you and I have both seen cases where these people are in dire straits and very at risk.

So I would love to hear what that was like for you and then why you started to see this as a great opportunity to maybe address That kind of profound disorder. 

Kristin Arden: Yeah. I thank you so much for asking that question because that really, it goes back to kind of a pivotal moment in my career and really is why I'm here today.

And why I'm with Mindbloom when I reflect back one of the things that I remember is I went to state [00:07:00] hospital because I thought that going to the place where I felt people needed the most help, I would be able to have the biggest impact and see the biggest change.

And I figured it's a state facility. So that's close to maybe where regulations are made. And maybe I can have an impact on changing some of the rules of, uh, govern in mental healthcare practice and accessibility. And one of the things that stood out to me, and I think is, is that. Towards the end of my time there, I had been there for almost 10 years and nothing much had changed.

Anytime there had been a new option, a new possibility that could help people, it seemed like there was so much bureaucracy that we couldn't get that into our client's hands. And then I also, Notice that there was this narrative, you know, sitting through hundreds of case conferences and all of that where we talk about people's histories and what we've tried and future options for this individual is that there would be Individuals that a common narrative would be around their potential.

Is that like we've tried everything and this is kind of just it and [00:08:00] that's You're a fortunate individual, a client, if you have medication that you don't have too bad of side effects from that maybe help you get through the day in a way that's tolerable. But there was a group of people were like remission and recovery just weren't really an option and something, I didn't know what it was, but it's something within me that But just like that didn't feel right to me.

Like, I didn't believe that I didn't know what the solution was but I just wanted to believe, I guess, that there was something better out there. And so that's the beginning of my journey to explore what are the available therapeutic options and how can I get myself in a role where I can have an active part in getting those Treatments into the hands of the people that need them. 

Kerry: I have a client coming to mind right now where I sat across from her and she tried everything This was a form of depression that refused to respond and this is a high functioning individual smart career oriented woman who had reached the end of her limit because there was nothing else.

And she was now facing the possibility of [00:09:00] ECT and feeling very terrified over that. And there's huge consequences to ECT. I mean, there's a short term memory loss. And I have worked with patients and actually saw them before and after and saw the memory losses, you know, saw the way the impact of them to have this form of treatment.

But when you're literally at the end of the road thinking, This is going to be the rest of my life and I cannot see a way out and I cannot function. And it feels like they often would describe it as I feel like at the bottom of a pit and I'm looking up and everything's dark and I have no choice.

I know for me, when I heard of the possibility of ketamine or psychedelic medications or therapies, then it's scary because I'm old enough to remember the 60s and 70s and free love. And I think, wow, you know, is that kind of a tripping? Now I want to let everyone know that I've actually done six sessions. So I have now.

Completed a protocol and it found it to be a profoundly impactful experience. And one of the things for me that made a big difference is we've been talking about PTSD, that when you're in a fight or flight response state, your prefrontal cortex shuts down. [00:10:00] You can't think out of the box. Literally, you're all the parts of the yourself that have for clarity are gone.

And so you're limited to just this. Overly intense arousal experience, and what's nice is, ketamine, seemed to me like it quieted that part for me, so that I could then address some things that I've not thought about before. One of the things I was super impressed about the program is you really include so much guided direction I mean, this is not just something that you do in the privacy of your own home without safety There's a tremendous amount of oversight that happens to where this is a very therapeutic experience. I always journal before I started I journaled after I started, you know, I watched for my dreams I kind of paid attention to themes coming up to me I felt very safe doing this, but I'd love to have you speak more about why this is such a powerful treatment for people who feel like, you know what, I've tried these other things.

I've tried talk therapy, maybe I've tried EMDR, maybe I've tried DBT. Why do you think this is something that might be part of the repertoire that they consider? 

Kristin Arden: I like to think [00:11:00] about how Ketamine works differently than The other options that we've had available to us and one of the key things that I think makes Ketamine effective in these type of instances is the fact that ketamine works in two ways So one way is in your brain what it does is ketamine works has had a restorative fashion in your brain So best way I like to describe it to people.

It's like fertilizer for your brain So it's a medication that repairs a lot of the key areas of our brain that are critical to our brain for recovery. So I think about why a lot of therapies might fail is because there's critical components of our brain are beaten down and tired from years and years of a chronic stress response.

So ketamine from a brain standpoint provides the individual with a really like a prime state to do work. And then you have the experience component of it. So the second way in which ketamine has an effect. So you're thinking about the person's brain is primed and ready to do work and now we have an experience.

, the best way I like to describe how Ketamine is really just a [00:12:00] great tool to reduce our defense mechanisms and allow us to really go deep and connect with ourselves, our true self at a deeper level and feel safe uncovering deeper parts of ourselves. a lot of people ask me, well, that sounds scary. Like, what if I see myself and I don't like myself? What if I come across this experience that was really traumatic for me and I'm not ready for that. We're only going to access things when we're really truly able to and when we do access things it's through a lens of love and compassion and that's what I think is really helpful with healing. The other, uh, component of the experience that I think is really valuable for people is I always like to think about our experience with ketamine as kind of like a mini version of our universe or the world around us.

And so in our experiences, sometimes practice things that we would want to then be able to do outside of these experiences, similar to like in group therapy, right?. A lot of times we. Do group therapy to practice our communication skills with other people in the group or [00:13:00] frustration tolerance with somebody that might, you know, annoy you in the group.

Same thing. I like to think about how we can use ketamine as a tool is to practice things that we would want to be able to practice in our daily lives. One of the big things is quieting our mind, seeing thoughts come in and being able to allow those thoughts pass through. Another big part that I see valuable is Slowing down our response to things.

So these experiences, I think you have such a sense of calm that come over you. And a lot of times it's with people that don't know what that feels like. So they're able to identify like, Hey, I actually have this ability to sit and feel peace, reflect on my thoughts. And it's like they leave those experiences and then their daily life thoughts come up.

They can see the thought and maybe they just have a split second. Sometimes it's all you need. To redirect your thoughts or how you respond to that thought. So it's almost like some of that sense of peace and calm from the experiences and individuals are able to take an insert [00:14:00] into their life and help them cope with different triggers and things that come up.

Kerry: How do you see it work that way, Shari? I'd love to hear your opinion as well. 

Shari Botwin: So when I think of PTSD and trauma, I think about. Not just the way the brain processes or is wounded, but the impact it has when we try to sit in our bodies. There's so much of what happens to people. Even again, if it's around something like narcissistic abuse, where all that shame and anger, despair, disappointment, we end up holding a lot of that in our bodies.

Because when you live with someone that you don't feel safe with, you can't express. What you feel you don't get the support that you need and during that time you don't know how to tend to your hurt self because that's something that we learn I think through healing. When I think of the ketamine I think what it does is it quiets the panic and urgency that comes with When we're triggered, when we feel like imminent danger, or we feel like we're going to go into flight or fight what I'm seeing with [00:15:00] my client is in the past when she was triggered, she'd become very hyper vigilant and sort of like frozen and then.

After she realizes that, then she becomes suicidal. What I'm seeing now is that she's actually calmer as she goes through the feelings, and more comfortable sitting in her body, and knowing that there are things that she can do to tend to her body. So I think that's something that the ketamine offers that I haven't seen in my practice with regular pharmacological intervention.

I work with people who've had ECT. I work with people who have done TMS. I work with people who do EMDR and I've seen amazing results with those strategies, but in cases like the one that I'm talking about, this particular type of therapy, the ketamine, it offers something different and it's more of a mind body experience versus.

Just focusing on the brain. It's like focusing on the whole self, which is

Kerry: yeah 

Shari Botwin: healing is about it's about taking the [00:16:00] parts of us That split off and carry and store certain parts of our trauma and parts of our body and brain and it's about Integrating and bringing that all together. 

Kerry: I got to hear dr Vander Kolk at a Workshop speak in person, which is fabulous to be in the room with this man, and I really respect his book, the body keeps the score, but he was saying in the United States that 80 percent of Americans have experienced what he called class a trauma. And I'd love to know what a class a trauma means, but I took it as is very serious.

And he says of that 80%. 60 percent go ahead and recover spontaneously. Because of a good support system, because of the resources they have in their life, 40 percent gets stuck. The question then in the trauma field wants to know why does a 40 percent get stuck? What's been shocking about narcissistic abuse is the statistics coming out is that of everyone who survives a narcissistically abusive relationship, which I am a survivor, 75 percent gets stuck.

And what I've noticed when I work with the individuals and meet people, because I have group support and also do group coaching, is that there [00:17:00] seems to be a I don't think there's a research on this but I've noticed that there's an increase of generalized anxiety and specifically a mild form of agoraphobia that develops where you begin to perceive that the environment and relationships and new people are threatening because you get into this relationship with somebody who's so deceptive and you think you've met somebody wonderful and safe and you discover this person that it's basically a lie, that you've been conned.

So then you walk out and you distrust your perceptions and your sense of self, because you got into that bad relationship, you assume then the world's more dangerous than you originally thought, which makes you just anxious. What I found was when I used Ketamine myself for the, through your protocol, is that I could say I was safe and it created a sense of extreme calmness and interestingly enough, my first experience, I did have a disturbing image and I sort of a kind of a vision. And I said to myself, you're safe. You're here. You've met with your guide. You're going to meet with her again. This is a process. [00:18:00] It's showing you something. So be curious about what it's showing you. And interestingly enough, I made probably the biggest breakthroughs in that session because I first was in a state of calm because it calmed me down, but also that I could trust the process that was revealing something.

And I had this massive breakthrough for me that was like, Oh my goodness, I had no idea. Interesting that darkness shifted into something really beautiful and very freeing, and I was able to make sense of it. So I love the fact that there is an opportunity for us to sort of bypass this vigilance because the body is, gets such in a state of arousal and we get used to it.

The thing that's so toxic about these relationships is that some of us are in this for years and we don't even know that we are in the state of fight or flight. Meanwhile, it's having all this sort of negative consequences for us. So here's another question. I know this is something you guys talk a lot about, but I think most people don't understand what it means.

But let's talk about neuroplasticity, because that's a huge important concept here. In general, [00:19:00] how changeable is the mind once you reach adulthood? Because the old thought used to be, well, the brain doesn't change because they can't grow neurons, because once the neurons have died, then it's permanently gone.

I know that we now know so much more. So can you speak to that? 

Kristin Arden: Yeah. I think debunking our brain being an egg in a frying pan, right? Yeah. No, I think that's another great question. Something that I talk to my clients a lot about too, is that they come in to treatment a lot of times with the idea that their brain is broken and they can't fix it.

And what I tell them is that you have the potential to have multiple more brains in the years that you have in front of you. There's been some really interesting studies about ketamine and what it does in the brain around neuroplasticity. There's a study that essentially looks at a healthy brain, like a quote unquote healthy control brain, and then looks at a brain of an individual that's had chronic depression and stress over a period of years.

And then it looks at that same group of individuals brains, one [00:20:00] day post ketamine treatment. And what we see is that one day post ketamine treatment, that group of individuals that have suffered chronic depression and acute stress looks very similar to the healthy controls brain. And the way that the brain looks, best way I would describe it is that the healthy control brains, it looks kind of like similar to what you would see as a tree in the springtime.

It's very like. vibrant, full, lush, like there's a lot of connectivity. So you have all the different neurons and branches of the other parts of the tree of our brain and they're all interconnected. So that means that if you think about how thoughts work, if we were to send a thought up the trunk of that tree, that thought has in the option to go through all these different pathways to process and respond to where the brain of that individual before treatment Like, very much like a tree in the winter, where we just imagine trying to send a thought up the trunk of that tree.

There's few branches and not a lot of options for that branch to go different places, let alone go up one place and say like, Hey, [00:21:00] might I be able to process this in a different way? It lacks a lot of resources from a neurobiological standpoint. So that's in a sense, like summarizes what neuroplasticity is.

It's like the ability of our brain to form more pathways, more connections, and like beef up the pathways and connections that already exist. And that happens very quickly. And there's so many things that we can do too besides taking the medicine that reinforce neuroplasticity. One of the, my favorite sayings is that if you don't use it, you'll lose it.

So it's like we do the work, we take the medicine, the medicine gets us started on that process of building neuroplasticity. It kind of kickstarts things for us. And then a lot of it is up to us. To do the daily, like some, there's very simple daily practices that you can do that reinforce neuroplasticity like journaling's a big one, saying affirmations, even just mild exercise.

All of that just like reinforces those pathways that the ketamine [00:22:00] treatment has laid out for you. 

Kerry: So who is this not for? Let's talk about How someone could know if they should consider this as a candidate and who it really is not applicable to. 

Kristin Arden: Yeah, so I can speak specifically to Mindbloom's protocols.

And then I will say with the caveat that there's a lot of different protocols out there. There's a lot of different paradigms or views on how. Ketamine treatment should be provided. So every practice you go to might be a little bit different, but there's general similarities from one practice to the next on selection.

So I'd say at Mindbloom we treat major depressive disorder, generalized anxiety disorder, and PTSD with a variety of ranges of severity from mild to severe. We also don't require an individual to be treatment resistant. We will treat people who have not pursued other treatments. The understanding that sometimes people haven't pursued other treatments because of their beliefs or fears around it.

Maybe they know somebody that's had a bad experience with [00:23:00] SSRIs. We believe ketamine is a, So really a safe and effective tool as a first line treatment for depression, anxiety, PTSD. So those are the primary indications. Things that would be exclusions for treatment, I'd say that the best way to answer that question would be to set up a consultation with a clinician to go through the details of your background and history.

From a high level, I'd say like serious cardiac conditions, it would be like the main, the factor that would rule out someone for treatment 

Kerry: as a figure, probably pretty serious. Psychiatric conditions would be a concern, right? Yeah. That 

Kristin Arden: side of things like schizophrenia, untreated bipolar one in a manic state or mixed state hypomanic.

People do treat bipolar disorder, bipolar two, or if someone's in a depressive state. Yeah. 

Kerry: One of the things I was super excited about was that my sons and I are autistic and what that's meant for our family is we have a lot of anxiety. I've struggled with anxiety. My kids have struggled with anxiety. So my oldest son also [00:24:00] participated in this because he actually jumped at the chance because it's like, Oh my goodness, it's been so debilitating.

And you know, honestly, and I feel emotional sharing this. I didn't know. How much he was struggling. He hadn't really shared that with me. And um, he said after his first session, and it hit me hard, he goes, for the first time in my life, I don't have this underlying deep fear. I always live with this deep fear.

And I'm thinking, oh my goodness. I mean, as a mom, I had no idea. That he was struggling through that kind of difficulty. So I, I, I just, yeah, I'm so thankful and I see him different. In fact, we just got back from a trip to Europe and he did things that I know that in the past it would have really kind of, he would have gotten in his own head and he would have kind of gotten scared as overly self conscious.

And I'm sorry, I've just really like moved me because it, you know, you don't want to see your kids suffer. He had really not let me in on how bad it had been for him. So, to kind of wrap things up, what else do you think that maybe I should have asked today that I didn't, that you really would love to kind of leave people with about healing from trauma and maybe [00:25:00] using ketamine as a way to do that?

Shari Botwin: I think one of the things I'm thinking about is just all the unconscious beliefs that we develop after. Living through things like childhood abuse and how most of us could spend years or decades of our lives not even knowing that those unconscious beliefs are there or that they're impairing our ability to function and live a full life.

The one thing that I see with the ketamine is what it also does is it allows people to break down those defenses and go from being unconscious about their beliefs to starting to have awareness. And I think that awareness is key in recovery because so much of trauma or, and PTSD is unspoken, undigested, not dealt with beliefs, thoughts, feelings, experiences that we may not even have conscious access to.

You can't heal from something if you don't know that it's there. Mm-Hmm,. So again, with my client, she's recognizing that. These earlier childhood abandonments [00:26:00] and the narcissism that was put on her by her mom, the defenses that she has built up and the lack of awareness that she has had about where those feelings are coming from, what the ketamine is doing is it's allowing her to start to become aware and then Talk about it and then grieve for that part of her that shouldn't have had to go through those experiences.

Kerry: Yeah That's what i've saw as well So what i'd love to do is jump over the podcast extra and talk about how to make the most of increased neuroplasticity You mentioned that Kristin some steps that we could do. I want to talk about what are other steps How do you actually maybe know that that's happening?

Is there a way to know? So I want to kind of hop over and talk about those things. But if somebody would like to learn more about this, maybe even find out if they're a candidate, where should they go? 

Kristin Arden: Yeah. So the best place to go to would be our website at Mindbloom. com. There's a button on our landing page that says, am I a candidate?

And that'll take you through the initial process. There's a couple [00:27:00] initial screening questions to make the first initial understanding of if you might be a candidate or not. And then that leads you to the next step, which is a more detailed client history intake form, and then you can book a consultation with the clinician who will get to know you a little bit better.

It's a psychiatric evaluation. So they'll learn a little bit more about you to help identify if this is a good fit and make a recommendation to you. And then if so, provide you a ton of education and information about that. program. 

Kerry: That's great. Thank you so much.

And I know that also there's a coupon code that I'll be including in the show notes. So if people want to take advantage of that and would like to get a discount, please check that out as well. Thank you so much for being on today, Kristin and Shari. I really appreciate it. This has been so fascinating.

And thank you so much. 

Kristin Arden: Yeah. Thank you so much for having us. 

Kerry: Well, that's a wrap for this week's episode. Are you following me on TikTok, Facebook, Instagram, and YouTube? Find me at kerrymcavoyphd and whether you're in, consider leaving, or have left a narcissistic relationship, [00:28:00] find community support at my Toxic Free Relationship Club. You can learn about this resource as well as others at Kerry McAvoy PhD dot com and I'll see you back here next week.

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