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You know that sinking feeling when you wake up with a hangover and think: “I’m never doing this again”? We’ve all been there. But what happens when you follow through? Sonia Kahlon and Kathleen Killen can tell you, because they did it! They went from sisters-in-law, to Sisters in Sobriety.
In this podcast, Sonia and Kathleen invite you into their world, as they navigate the ups and downs of sobriety, explore stories of personal growth and share their journey of wellness and recovery.
Get ready for some real, honest conversations about sobriety, addiction, and everything in between. Episodes will cover topics such as: reaching emotional sobriety, how to make the decision to get sober, adopting a more mindful lifestyle, socializing without alcohol, and much more.
Whether you’re sober-curious, seeking inspiration and self-care through sobriety, or embracing the alcohol-free lifestyle already… Tune in for a weekly dose of vulnerability, mutual support and much needed comic relief. Together, let’s celebrate the transformative power of sisterhood in substance recovery!
Kathleen Killen is a registered psychotherapist (qualifying) and certified coach based in Ontario, Canada. Her practice is centered on relational therapy and she specializes in couples and working with individuals who are navigating their personal relationships.
Having been through many life transitions herself, Kathleen has made it her mission to help others find the support and communication they need in their closest relationships. To find out more about Kathleen’s work, check out her website.
Sonia Kahlon is a recovery coach and former addict. She grappled with high-functioning alcohol use disorder throughout her life, before getting sober in 2016. Sonia is now the founder of EverBlume, a digital tool that offers a unique approach to alcohol recovery support.
Over the last five years, she has appeared on successful sobriety platforms, such as the Story Exchange, the Sobriety Diaries podcast and the Sober Curator, to tell her story of empowerment and addiction recovery, discuss health and midlife sobriety, and share how she is thriving without alcohol.
Her online platform EverBlume launched in February 2023, and was featured in Recovery Today Magazine and deemed an ‘essential sobriety resource’ by the FemTech Insider.
The company champions self-improvement and mindful sobriety, with support groups designed by and for women struggling with alcohol.
So how can EverBlume help you meet your sober community? By offering deeply personalized support. Members get matched based on their profiles and life experiences, and take part in small group sessions (max. 16 people). In your support group, you will meet like-minded women, discuss your experiences, and gain confidence, knowing you can rely on your peers in times of need.
Whether you identify as a binge drinker, someone who developed a habit during the Covid-19 pandemic, a high-functioning alcoholic, or an anxious person using alcohol to self-soothe… There is a support group for you!
Current EverBlume members have praised the company’s unique approach to alcohol detox. “No one is judging me for not being sure I want to be sober for the rest of my life” ; “I felt so heard and understood and today I woke up feeling empowered to make the change in my life”.
Feeling inspired? Learn more about the EverBlume sobriety community at joineverblume.com, or simply listen to Sisters In Sobriety.
Your sobriety success story starts today, with Kathleen and Sonia. Just press play!
[00:00:00]
[00:00:53] Michelle: Welcome to Sisters in Sorority and today we're diving into a topic that's been [00:01:00] generating a lot of buzz in the addiction treatment community and that is the use of psychedelics in recovery.
[00:01:06] Kathleen: Psychedelics have long been associated with counterculture and recreational use, but recent research is uncovering their potential to aid in addiction treatment. From psilocybin to ayahuasca, these substances are being studied for their ability to help individuals break free from the cycle of addiction.
[00:01:24] Michelle: One substance that's been gaining particular attention is ketamine and ketamine is being used in controlled therapeutic settings to treat depression, PTSD, and addiction. Offering new hope for those who haven't found success with traditional methods.
[00:01:40] Kathleen: Joining us today to shed light on this fascinating topic is Michelle Hodesco. Michelle is a highly experienced therapist who has worked as a perinatal psychotherapist, a lactation consultant, and a postpartum doula. So what does this have to do with ketamine?
[00:01:55] Kathleen: Michelle's dedication to innovative treatment methods is evident in her recent [00:02:00] certification as a ketamine assistant psychotherapist. Michelle, thank you so much for
[00:02:04] Michelle: I'm so excited to chat with you guys about this and explore it together.
[00:02:09] Kathleen: So I alluded to this in my introduction, but you've, you have primarily been working in perinatal, psychotherapy, lactation consultant, postpartum doula. Can you share a little bit about your background and what inspired you to explore psychedelic therapies in your
[00:02:26] Michelle: Yeah. I'm sure my whole family is wondering the same thing. Like how did you pivot to psychedelics from working with mothers and babies and families? and they're not really related, honestly. it's more of a, a personal journey that I had. I had a pretty traumatic injury several years ago that led me to having some moments of what in the psychedelic space we call like non ordinary states.
[00:02:51] Michelle: And you can reach a non ordinary state in many different ways. Sometimes drug induced, sometimes injury induced, or Even through [00:03:00] meditation, there are many ways that we can reach that space in our brains. and it was pretty profound for me. I won't get into the details cause the autobiography has not been released publicly yet.
[00:03:11] Michelle: but it just, it unlocked a whole nother dimension. and just a different way of thinking. And I didn't know what the connection would be at the time. That was many years ago. I kind of just. Couldn't even tell you, I found, fell down like a rabbit hole on the internet one day, and found myself just reading pages upon pages about psychedelic assisted therapies and all the new research coming out, and I was just getting so excited about it because it just felt really hopeful.
[00:03:40] Michelle: And I think anyone working in a mental health related field Would share that sense of hope when any new therapy comes out. You know, and I say new lightly, these medicines have been around forever. Um, but it's newly being recognized as like socially accept acceptable, in the [00:04:00] US to be used clinically, under the guidance of doctors.
[00:04:03] Michelle: These are practices that used to be used in indigenously, in tribes and in other cultures. And. we're learning something from them and There's a lot of hope that it could be a way that, that some people get the treatment they need and it's not a cure all It's not a panacea for everything And anyone who claims anything is like big red flag So same thing with the psychedelics.
[00:04:29] Michelle: It's not gonna work for everybody But if people who had treatment resistant depression or struggling with addictions, really acute PTSD, etc., some of these more difficult to move, um, Mental health conditions, they're willing to try anything, you know, when, when you've spent years and you've tried all the different drugs, you've tried different therapies, like, it's another one to try and for some people, it's the thing that helps them and [00:05:00] changes their life.
[00:05:01] Michelle: so Michelle is a friend of mine. And I've been talking to other people and telling them like, Michelle is doing this ketamine treatment. And so there's a lot of skepticism. So how do you address that or like resistance from patients or their families about psychedelic therapy?
[00:05:16] Michelle: Yeah, I think a healthy amount of skepticism is good. And I would be worried if you weren't worried, like we should have a lot of reverence and respect for these medicines. They're powerful. They're sacred, they've been around for millennia and they they do powerful things So it's good to question anything and especially with psychedelics to be just a little bit Curious about what to expect.
[00:05:46] Michelle: Is this safe for me? Because a lot of the bad rap that these medicines have gotten have been from people who've experimented with them and not had the right set setting [00:06:00] and support afterwards. So, that's not to say that you can't do it recreationally, don't tell me about it if it's not legal in your state, but people who do these drugs recreationally have a very mixed bag of experiences.
[00:06:14] Michelle: and a lot of what it boils down to when we do psychedelic therapy in a container with professionals, we're following an outline of, preparation, doing the dosing together and integration afterwards. And part of the preparation is, are you a good candidate for this? And there are things that exclude some people.
[00:06:34] Michelle: So those people that would be excluded from therapy, if they did these drugs at a party, they might not have a good experience.
[00:06:42] Kathleen: so can you, can you expand on who might be excluded? Okay.
[00:06:45] Michelle: so the main ones are, um, anyone with a history of psychosis, schizophrenia, bipolar disorder, Some people will say hard no to any bipolar disorder, others will say [00:07:00] no if you have bipolar and you're in an actively manic state so, I have heard of people with bipolar disorder having psychedelic.
[00:07:07] Michelle: therapy treatment and doing well with it, as well as, as long as it's well managed with their other mental health, team.
[00:07:17] Kathleen: okay. So, what do you think is the biggest misconception about psychedelic therapy?
[00:07:23] Michelle: I think unfortunately, because a lot of people have had a lot of fun with these drugs, it's not being taken seriously as a powerful medicine, because I would imagine most people in our Western culture think about. You know, mushrooms specifically, you're thinking about people at festivals and yeah, people at festivals are doing mushrooms and there are more groups going to those to support people on their trips.
[00:07:52] Michelle: good, bad and different. But, not enough of us are thinking about where the origins of psychedelic [00:08:00] plant medicine came from. And it came from indigenous cultures that were using it in a really sacred, respectful way and they were having. different experiences than what the stereotype is. So there's kind of a mixed bag in the U.
[00:08:16] Michelle: S. right now with some leaning more towards a very medical model of wanting it to be very controlled and, a bit more rigid and manualized. And then there's another group of people leaning towards really trying to keep it sacred and ritualistic and rooted in It's indigenous, start.
[00:08:36] Michelle: That's so interesting. So we're obviously a sobriety podcast, but, one of the uses that is being talked about for psychedelics is in addiction treatment. So how do you see psychedelics? what is the role of psychedelics do you think in the future of addiction treatment? So while I'm not specifically trained in addictions, the, what I have [00:09:00] heard about where I think addictions.
[00:09:03] Michelle: can be helped with psychedelics are two areas. One is that there's a lot happening on like a, on a brain level, on a neurochemical level that with psychedelics, it creates a psychoactive effect in the brain that promotes the growth of neurotransmitters and it encourages more neuroplasticity, which a lot of people probably hear that word neuroplasticity thrown around.
[00:09:27] Michelle: It's a big fancy word and it just means brain growth. There was a time when we didn't even believe brains were capable of that, and they are, because they're amazing, but, Psychedelic therapies, and I know psilocybin specifically has had a lot of research around this, the neuroplastic effects after taking the medicine continue afterwards.
[00:09:49] Michelle: So this is part of why the integration afterwards is so important, because you have this really vulnerable space where your brain is open and ready to learn new [00:10:00] things and create new behaviors. So you have this really beautiful framework and this, this nice space to work with a brain that's more open to learning, whereas it may have been stuck and rigid in, in old patterns and behaviors before.
[00:10:15] Michelle: the second area that I think psychedelics can be really helpful in addictions is that it opens you to an expanded state. So similarly to the neuroplasticity of like your actual brain neurotransmitters are like open and ready to grow and create new connections on a behavioral, emotional, soul level.
[00:10:38] Michelle: It opens people up to having more depth of insight and experience because you enter this non ordinary state that's different than being on a drug that you're using recreationally. Especially with the set and setting and guidance that we're entering into this
[00:10:57] Michelle: session on. So, For [00:11:00] somebody who might be stuck in their way of thinking, it offers them a glimpse into another perspective, a deepened state, a really deepened perspective on their life, and then that combined with the brain being more plastic and open, it just sets the setting for change.
[00:11:21] Michelle: and growth, so I think that's where it can help break addictive tendencies if it's,figuring out what led you to your addiction? Was it some trauma in your past that needs to be processed? You know all the underlying things for like, why do you drink? Why do you pick up the drugs?
[00:11:36] Michelle: I think it can help get to that but it can be used in conjunction with other medications for addiction treatment, and it should be used collaboratively with a team so that you're still addressing, the addiction with your team.
[00:11:52] Michelle: it shouldn't be a first line approach psychedelics are not the first line approach to addiction. [00:12:00] And based on what the psychiatrist recommends, there are medications that are compatible with psychedelics.
[00:12:07] Michelle: I was wondering, so, I live in a very like a liberal area and people are using, different services to get ketamine mailed to them. So is it for everyone who wants to experience it or are there criteria that make somebody a suitable candidate for psychedelic therapy?
[00:12:27] Michelle: there are criteria, especially for people in the field, not just professionally, but people in the psychedelic space who really want to protect this because we've fought to get it in a place where we could use it therapeutically. And it's still. It's still a big work in progress, so we really want to be careful about how we're using it.
[00:12:49] Michelle: and because we don't want to do any harm, obviously. So, there are good and bad ways to do this, and there are people who are better indicated for it than others. [00:13:00] Some of what you were talking about, like doing ketamine at home, there's a lot of programs coming out with that, and I have mixed opinions about it.
[00:13:11] Michelle: I think it's a great idea. It's a great business idea. it's more accessible for a lot of people, which is a real thing, especially when ketamine clinics are few and far between. but there is room for abuse with that. So that's what I worry about with the at home treatments
[00:13:29] Kathleen: I can't really imagine just having access to that, like to, for delivery. so yeah, you would think there would need to be some pretty, pretty high boundaries around that. Yeah. Are there specific psychological conditions? I know you mentioned PTSD, or like personality traits, for example, that would make someone an ideal candidate for psychedelic therapy.
[00:13:53] Michelle: personality traits could be very open to anyone because There's certainly, your [00:14:00] deep thinkers who are already going there mentally and they want to expand even further with the assistance of a psychedelic. But I also think it's equally great for people who struggle to go there in a natural state that it, it opens up like their first opportunity of, seeing what their brain is capable of, you know, and, This is just my opinion of how I describe, my experience.
[00:14:25] Michelle: It feels very like imaginative, like dreamlike. And there's a like inner creativity and hope and playfulness behind that, that maybe some people don't have as easy of access to and psychedels can just open you up and expand you a little bit when you're stuck and contracted.
[00:14:47] Kathleen: I love that explanation. I could be more creative. But then actually when you were saying that I was like, what are other ways that canbring that about beyond psychedelics if someone chooses not to do [00:15:00] them. But I think that's a great way, Michelle, to, to explain it to you.
[00:15:04] Michelle: like a trampoline park? Is that what you're talking about?
[00:15:07] Kathleen: No. Ecstatic dance, Sonia. Ecstatic dance is what I'm thinking about.
[00:15:12] Michelle: think about how many musicians and artists, like great musicians and artists do you know over all time that have created their best work under the influence of psychedelics specifically, not just any drug. So people gain a lot of really deep insight with the assistance of psychedelics.
[00:15:30] Michelle: But like I said, it's something to pay reverence to because as much as it can be really beautiful and positive, it can also be very powerful in a more overwhelming way. I won't say a negative way or a bad way. A lot of people say bad trip, but. Anyone in the psychedelic space will give you the X on that.
[00:15:49] Michelle: There's no such thing as a bad trip, but there are challenging journeys. And when that comes up, it's because there's some stuff that you've [00:16:00] not fully addressed inside you and the plant medicine will bring it forward, whether you like it or not. And that's the piece that we need to be mindful of. if we've got some skeletons in the closet or some dark stuff lurking around, do we want it popping up at a party?
[00:16:17] Michelle: Or would you like to have your therapist there with you?
[00:16:19] Kathleen: My therapist, for sure.
[00:16:24] Michelle: I'd like to have my therapist with me in general, like as a companion. Like,
[00:16:31] Kathleen: a sister in law that is a therapist, so
[00:16:35] Michelle: me, actually.
[00:16:37] Kathleen: I'm like, I'm not your therapist, but
[00:16:40] Michelle: Oh no, so is Michelle. It's like, you should see what I did to Michelle. we're getting in the pool and I'm just gonna cry about stuff.
[00:16:48] Kathleen: I love that, but not that you're crying, So, okay, so Michelle, how do you determine if someone is not a good fit psychologically for psychedelic treatment?
[00:16:58] Michelle: think it also goes [00:17:00] back to the supports again because I can't imagine having a psychedelic experience especially if it was a challenging one but even a not challenging one and then going back to a toxic environment and I wouldn't say that this would exclude someone. I I don't know any therapist or psychiatrist that would tell someone, no, you can't have this therapy.
[00:17:24] Michelle: You can't have access to this medicine because you have a toxic household. You wouldn't be turned away, but it would be something I'd be very mindful of as the therapist that, you know, remember we have this neuroplastic state, this very vulnerable brain that you're leaving the session with. And then to go home to a toxic environment,
[00:17:43] Michelle: It it can really unravel a person if they don't have the right supports. So I worry most about the aftermath and what kind of supports people have in their life outside of therapy because a therapist can only do so much. I didn't even think about that, that thinking about [00:18:00] somebody's external, I was thinking more about their internal environment.
[00:18:04] Michelle: that is really interesting. Yeah.so this is something that comes up a lot when I talk about psychedelics with people is, what is the potential for substance abuse or dependency on psychedelics themselves? You know, psychedelic therapies can absolutely be abused, just like anything else, legal or illegal. And that's why I think it's important to be working with, a team of professionals that you align with and you feel comfortable with, because they're also people at the end of the day, so.
[00:18:36] Michelle: Whether they have a credential or not, if you don't feel safe and protected with them, I wouldn't do it. and this is, goes back to my feelings about the in home treatments, is it's very dependent on what professionals you're working with. There is a way to do ketamine in your home with a trusted therapist and have a positive experience.
[00:18:57] Michelle: but also there's a way [00:19:00] to potentially abuse this drug. without the right supports or any psychedelic therapy for that matter. it's not a cure all there. There definitely is space for abuse and I think that's why it's so important to have a really great team of medical providers working with you.
[00:19:22] Kathleen: what alternative treatments would you recommend, um, for people who are not candidates for psychedelic
[00:19:28] Kathleen: that may get them similar
[00:19:30] Michelle: Yeah, um, I would say obviously double check with your psychiatrist, but I wonder if there would be space for microdosing there, because microdosing is what it sounds like. It's a very, very tiny, tiny dose of anything, but with it brings you to a psycholytic state. So the difference between psychedelic and psycholytic is psychedelic is, I'm feeling it.
[00:19:56] Michelle: I'm tripping. Psycholytic, you [00:20:00] feel normal. You wouldn't know anything was in your system, but you're still getting, the benefits of the medicine on a much smaller scale. So you're not having visual changes or disturbances. you can go about your day and function completely normally, but it's still giving you some of that neuroplastic benefit to your brain.
[00:20:20] Michelle: and some people notice a change in their mood too, depending on the strains. If we're talking about psilocybin, and I think there are more reputable programs starting to come out that are giving, appropriate guidance about how to do that safely.
[00:20:36] Michelle: Um, and they are screening people to make sure that, you know, with the screening, they're more looking at people who are responsible with it, rather than, you meeting any kind of like personality criteria, really, Yeah, that's interesting.
[00:20:52] Michelle: So two weeks ago, we had John Kostas on and he was one of the first participants in a [00:21:00] psilocybin for the treatment of substance use disorder, study at NYU and, and I was surprised to hear it's a macro dose. He said the dose that they gave him was like. more than what someone, would take at Coachella.
[00:21:13] Michelle: It was like three times. And he said, it's not, you know, necessarily an entirely pleasant experience that you would want to repeat again. but I, I had no idea. I just associated psychedelics and therapeutic treatment with microdosing. So how do you determine the appropriate dose for each person? Yeah, I think that is an art that.
[00:21:39] Michelle: In this space, I'm leaving up to the psychiatrist, but, how people have navigated this when they're doing it on their own is a lot of trial and error. so that's a little nervy for people who are new to it. not just because, you know, if we're talking about psilocybin, it's not just, let me see how I handle mushrooms in general.
[00:21:58] Michelle: There are so [00:22:00] many different strains. the nice thing about psilocybin is it's a little harder to adulterate because it looks like a mushroom. It's not, you know, hopefully all ground up by the time you get it. So I think that does bring some reassurance to people. But if you aren't familiar with the strain you're working with, you can have a very different experience.
[00:22:22] Michelle: and the amounts of psilocin, which are the psychoactive piece, are variable in different species of mushroom containing psilocybin. So what is bioavailable to you in one strand is going to be very different than another strand.
[00:22:39] Kathleen: how are psychedelics administered in treatment? I guess it depends on what it is, but how would you typically administer
[00:22:46] Michelle: Yeah, there's a bunch of different ways. for places using the psilocybin mushroom, the most common are, like, you get them dried in different packets based on the dose that you're taking, [00:23:00] and you can make a tea with them, crush them up, and you put them in some warm water, Adding some lemon juice can help, it can help ease your stomach a little bit because sometimes that can give you some nausea, but it also amplifies the onset.
[00:23:14] Michelle: It doesn't make it a more intense trip overall, but it amplifies the onset because it's, you're digesting it more readily, and it tastes a little nicer. You can add a little honey to it, and it's not, it's not too bad. It's more palatable. other people will just eat them straight. if you like the taste of mushrooms, that's not too bad either.
[00:23:35] Michelle: Some people don't like that. those are the two most common in, a clinical setting. But, recreationally, I mean, people put psilocybin on anything, probably. A pizza. Yum!
[00:23:52] Kathleen: and that's how I would eat them. So, you know, that's, that's how I
[00:23:57] Michelle: Yeah, chocolate is a really common one, too. [00:24:00] That, on my experiential retreat. I had a piece of chocolate that I like chased it with, to add a little bit of sweetness without, you don't want a lot of food in your stomach because you can get nauseous. and to get the full effect, it's definitely more intense on a lighter stomach.
[00:24:17] Michelle: So I did have a light fast before my dosing on my retreat.
[00:24:22] Kathleen: So,
[00:24:22] Michelle: What are the differences between psilocybin and ketamine in terms of their impact on, on mental health? Mm-Hmm?
[00:24:31] Michelle: I would imagine there's probably a lot of similarities, the differences were getting kind of nitty gritty. I would say overall, a lot of it could be based off the individual's experience that some people physically metabolize one a little more easily than the other, have a more enjoyable experience with one than the other.
[00:24:55] Michelle: And when I say enjoyable, I don't mean like you've only had positive experiences, but it's just [00:25:00] been. easier to work through because not everything has to be a super big challenge to have benefit from. But I would say that both have a lot of potential for treating depression, anxiety, trauma, PTSD, addictions.
[00:25:16] Michelle: Right now what I think it boils down to for a lot of people is accessibility with what's legal and what's not and what's, what you can get where you're living and where you can find supports for that too. Because when we go back to the talk about integration, great, you have access to these things.
[00:25:34] Michelle: And then what do you do afterwards? I think that's, that's important too. And a lot more providers are trained in ketamine than psilocybin because ketamine has been around for ages used as an anesthetic. So, More doctors and more providers are familiar and more comfortable with supporting that just because it's been around longer, but not necessarily because it's proven to be any safer.
[00:25:57] Kathleen: So, Michelle, what, what are the [00:26:00] psychological preparations needed for a safe and effective treatment session?
[00:26:05] Michelle: Yeah, this is super important. So now we're starting to get into the the three part approach of doing psychedelic assisted therapy with a therapist. And the first thing being the preparation. So the preparation is a tag team approach with a psychiatrist. So ideally, in a perfect world, finding a therapist that you love who's partnered with a psychiatrist that they have a good relationship with too.
[00:26:32] Michelle: Because they need to be working together on your treatment plan. This is ideal in any medical field. It usually doesn't happen,* but*
[00:26:40] Michelle: I know I've met a couple at least two or more Psychiatrists in my area that I have good relationships with and I feel so fortunate for that because I don't think that It's common everywhere, but I think that's going to be super helpful for my clients.
[00:26:56] Michelle: so partnering with a therapist and a psychiatrist, [00:27:00] your psychiatrist is going to do your initial intake, to talk about your medical background, your mental health history, any medications that you're on and any contraindications as far as like cardiovascular conditions mainly and blood pressure are two of the big ones that are sometimes flagged because you can have elevations and fluctuations in those when you're under the influence of psychedelics.
[00:27:25] Michelle: So those things are monitored under some conditions, especially with ketamine they are. Right now with psilocybin, I I know Oregon is taking a non medical model, so those things aren't monitored, and there are a lot of logistical reasons and political reasons behind that. so you meet with your therapist, Talk about your interest in ketamine, meet with the psychiatrist, get your medical intake, your mental health intake.
[00:27:52] Michelle: They give you the thumbs up that this seems like a go for you. they can either prescribe an oral lozenge that you take to your [00:28:00] therapist's office and you do it in your therapist's office with their company, or you can have IV or IM ketamine with the psychiatrist. at their location or somewhere with a nurse or nurse practitioner.
[00:28:14] Kathleen: We have people from all different countries around the world. So what your process that you're talking about is US based, right? US based. I just want to make sure our listeners know, cause I think it might be a bit different where I'm living,
[00:28:27] Michelle: with Canada.
[00:28:28] Michelle: but yeah, this is all U. S. based information. so once you've gotten the logistics of, you've got your care team of your therapist and your psychiatrist, you've got the heads up, you've got the prescription, You're, you've decided where you're gonna dose, whether you're at your psychiatrist's office, or your therapist's office, and what mode.
[00:28:49] Michelle: Then you're gonna do some preparation therapy sessions with your therapist without any psychedelics involved. So this is important because there's a lot to talk [00:29:00] about before we're under psychedelics. We don't just, pop them, and hope for the best. part of the set and setting that you'll hear me reference a lot is creating the right container for this kind of powerful medicine to be utilized in a meaningful, productive, beneficial way.
[00:29:19] Michelle: So, the preparation is a lot mental, emotional. So, talking with your therapist about, what kind of things do you think might come up? What are you anticipating might come up? What are you worried might come up? And also, you can set intentions for what you'd like to come up, but you don't really have a say.
[00:29:39] Michelle: so, we set intentions to go in with some purpose, and it can give you a framework, especially if you're smart about keeping it pretty vague. but you can't say, I want to work on this thing when I do ketamine this time, because once you're under, it's out of your hands. And it's really interesting sometimes [00:30:00] what will come up for some people versus what they go in thinking will come up.
[00:30:04] Michelle: but we, we trust the body's inner wisdom to bring forth what needs to come up at that time.
[00:30:09] Kathleen: Amazing. That's really helpful to know.
[00:30:13] Michelle: So Michelle, can you describe a typical psychedelic therapy session? Yeah, so I can tell you, doing oral ketamine, there are two different ways to do oral ketamine. There is a liquid, which is not as common, but I've done that personally. it's the same kind of protocol that you would do with a lozenge.
[00:30:35] Michelle: So the lozenge is just like a tab, or they call it a trochee sometimes. It's a tab that you put in your mouth and it quickly disintegrates. So when you do the oral version, whether it's the lozenge or the liquid, you're going to hold the medicine in your mouth and not swallow it. So, this is, this was news to me too when I learned about this.
[00:30:57] Michelle: it's not something that you're going to swallow at [00:31:00] any point in the session. So, during, in the initial phase, you're going to hold the medicine in your mouth, your mouth is going to pool with saliva. Okay. And periodically if your mouth fills up with too much saliva, you can spit into a cup, but you want to mostly hold the medicine in your mouth so that it gets absorbed through your salivary glands.
[00:31:20] Michelle: But it's not a super pleasant taste.
[00:31:23] Michelle: it's not something you want going down your throat. So, it's not for me. It's easy to avoid swallowing. So you'll hold it in your mouth for anywhere from between like 15 to 30 minutes, I know some people have had to hold it a little longer for a fuller effect, if they're a little more resistant to it, while others who are more sensitive might spit it out a little sooner.
[00:31:42] Michelle: Thank you. So after that time is up that you've held the medicine in your mouth and you've switched around to of distribute it around your mouth, you'll spit the medicine out into a cup. And usually you're, you can be given a chaser of something sweet to get the taste out of your mouth, some apple juice or orange [00:32:00] juice.
[00:32:00] Michelle: So there's the oral method or you can do IM intramuscular, which is a needle right into the side of your arm here. Um, it's pretty common that you can have the option to be offered a booster dose with that. So, You'll discuss with your psychiatrist what they think an appropriate dose is for you and usually It varies how how far into the journey someone will come in and ask you but a medical provider Will come in at some point early on and check in with you and ask you would you like your booster?
[00:32:32] Michelle: And you can either decline and say you know what this is feeling pretty good. Let's stop here or certainly if you have the wherewithal to To say yes, you're probably, you might be wanting more. Not everybody wants a big big dose But it gives you the option for just a little boost to get a little bit more because a lot of people are really unsure About how much they want to do so they might start off kind of gentle and you can bump it up in the same session If you're feeling like [00:33:00] that wasn't enough the benefit with Intravenous is that it's a steady flow and it's a bit more adjustable in the moment than I am or oral But I wouldn't say around me at least here in Pennsylvania in the States I'm seeing I am and oral being the most common But those are the three different ways that you can have There's also nasal, it's a different, it's a little bit different, it's esketamine, it's a little bit of a different creature than just ketamine.
[00:33:33] Michelle: It's a bit less, bioavailable, There are a lot more esketamine clinics, and that is just a nasal spray in the clinic office.
[00:33:42] Michelle: and then at that point you lay back As if you're going to take a nap. So the way it looks at a lot of places is you'll have a bed or a couch or a recliner that you'll be comfy in with blankets. You come in the comfiest clothes. Don't try to look cute, wear your [00:34:00] sweats, wear your yoga pants, wear a hoodie.
[00:34:02] Michelle: yeah, don't worry what you look like at all. Just come a hot mess like you're going to go to bed and get snuggled up. And some places will give you an eye mask and headphones. So, music is a really big part of the journey, regardless of the mode of dosing. The music acts as a literal soundtrack to your journey.
[00:34:24] Michelle: So there are music therapists who put a lot of thought and intention into creating soundtracks that will support your journey. A psychedelic journey, so that there's a slow increase easing you in, some peak, and creating a little bit of tension, just enough to facilitate something to happen for you, and then it eases you back down, so that you're not left up here.
[00:34:49] Michelle: So the music is going to guide you on this gradual journey, and it helps you to go deeper, just like the eye mask helps you to go deeper. If you did this medicine and you sat [00:35:00] wide awake and tried to talk to somebody the whole time, it would just be a very different experience than if you were in a calm, serene room, maybe there's some aromatherapy, the lights are dim, you've got an eye mask on, you're snuggled up with a blanket, and you're listening to some beautiful music.
[00:35:17] Michelle: That really sets the setting. So when I describe that and then you think about doing it at a party or a festival, they're just different. there's no judgment on, on doing it recreationally in a safe way, but you can see where it leaves more room open to feeling unsupported if things go a different direction than what you were expecting.
[00:35:38] Michelle: So who determines the soundtrack? the therapist. Would be in charge of the soundtrack. the music is really important and especially, not just that your technology is working well, but also that you're not like, for instance, playing something from Spotify and then an Olive Garden commercial pops on and it totally takes you out of your experience.
[00:35:58] Michelle: So I've had that [00:36:00] happen with people where they've told me about it, that, a commercial came on during their soundtrack and it like totally threw them off. It was salvageable, but it's not ideal. you have a soundtrack that you could provide? Yes. Yeah. Okay. I, I'm lucky enough that the group that I've partnered with has an amazing music therapist who's created several beautiful, awesome soundtracks.
[00:36:22] Michelle: the client can receive a link to the soundtrack that they listened to on their journey because re listening to it in an ordinary state after your treatment can help you process it.
[00:36:36] Michelle: , so what is. the role of the therapist in the session?
[00:36:41] Michelle: So the therapist role, a lot of it is holding space, which is a small little phrase that encompasses so much and it looks like nothing, but it's so important. Um, I know a lot of my doula and birth space people know [00:37:00] this term well and mental health professionals know this term well that.
[00:37:04] Michelle: It's really just being in the room with someone, gives so much comfort. but additionally, we've spent the prep sessions prior to the dosing session building rapport and relationship. Because, A lot of people are nervous, especially their first time, but sometimes every dosing session, there's a little bit of nerves that like, I don't know what I'm about to meet on this journey.
[00:37:26] Michelle: I don't know what I'll encounter. Will it be light and fun and easy or will it be sad or will it be a little scary? And I want to know that a, I have someone in the room with me who's in an ordinary state if I need their support and B that they're experienced with, Guiding people through using these medicines that they've done it themself as well and they know what to expect and they can understand the kind of feelings that might come up and That they have a safety plan for [00:38:00] you
[00:38:00] Michelle: so can somebody have a bad trip? so, yes, that is possible, but we're really working to change the verbiage around that. That bad trip has been the term that's been used for many, many years, and that's what people are most familiar with, which is why I said yes, initially, because I know what you mean.
[00:38:19] Michelle: but the idea of a bad trip, to me, as someone who does, dream work, is the same thing as saying, I had a bad dream, or I had a nightmare, None of it is bad, it's coming to you with good intention and there's a lesson and there's meaning there, but it might be challenging, it might be difficult, it might not be fun and light and beautiful like psychedelics are portrayed often as like, I'm gonna see wavy signs in the air and everything's gonna get fuzzy and groovy and it's not always like that.
[00:38:53] Michelle: you don't have full control about what comes up, but if there's some dark things that have been hidden [00:39:00] away, or stuck somewhere, that you haven't been able to access, we want the psychedelics to help bring them up. The art of how to do this gently, is what your therapist and your psychiatrist are working really hard to balance.
[00:39:16] Michelle: That we want to just, gently like, kind of agitate the ocean floor a little bit, but we don't want to start a whole tornado. So any kind of trauma therapist will agree with that too, that we're not trying to just rip the bandaid off and start a hemorrhage to get it all out. Like we want to just gently bring some stuff up, but it might be challenging.
[00:39:38] Michelle: And if you just had that challenging experience on your own, it. It's not impossible to integrate on your own, but I think it's more difficult if you don't have good support afterwards or you don't have an understanding of what that meant or what that was for. you could just leave that experience feeling like, well, I had [00:40:00] a bad trip.
[00:40:00] Michelle: That was terrible. I'm never going to do it again. I don't like that medicine. I'm not a good candidate for it. When really, maybe something really purposeful came up that have an opportunity to work with and you just need the right set and setting and supports to turn that into something positive. But it's hard work, like any other kind of therapeutic approach, like EMDR, other trauma therapies, it's going to bring stuff up.
[00:40:28] Michelle: That's the point. So how do you handle those sort of breakthroughs or insights that somebody gets in a session after the session? Well, I know during I can say a big part of my training is during the whole dosing session I'm watching my client very closely And I'm not intervening most of the time So just because someone's crying or they look in distress does not mean to intervene and this is where the skill of the [00:41:00] therapist is really important because Things aren't always what they look like.
[00:41:03] Michelle: They aren't always what they seem I can give an example of one of my own experiences I cried heavily through my entire ketamine treatment for like an hour. I sobbed. And anyone looking at that would have thought I was in a lot of distress and needed comforting when really I was processing some deep grief and it was beautiful.
[00:41:27] Michelle: And I was crying because it was so beautiful, but it looked distressing. And if someone had tried to comfort me, then it would have just thrown the vibe off. I didn't need it. I was okay. I just needed to feel that and be okay. So there is an art to knowing when to intervene and if it will be helpful or if you're getting in the way.
[00:41:45] Michelle: A lot of it is sitting back. But afterwards, we try to schedule in a big chunk of time on a dosing day so that there's time to come down from it gently. You have time to re acclimate to the world. If you want to talk [00:42:00] right away with your therapist, you have time then and there to be like, Oh. Wow. This is what came up for me.
[00:42:05] Michelle: I kind of want to tell you about it right now. other times it's too soon and you just want to sit somewhere. You just want to sit in that space. You're not ready to go back out into the real world. You're not ready to go back to your family. so we do schedule, at least 30 to 60 minutes of winding down before leaving.
[00:42:27] Michelle: and then afterwards doing some follow up integration right away because, the integration is really important, but we also talk in the prep about what to expect afterwards, and it, it isn't always immediate relief. and I think especially with ketamine, because it's being, advertised mostly, most heavily for treatment resistant depression, I think there's an expectation of I'm going to leave here feeling lighter and I'm going to leave here feeling less depressed and better.
[00:42:58] Michelle: And it doesn't always [00:43:00] happen that quickly. and sometimes if something difficult came up in your journey, you may momentarily feel a little worse and that is normal, but that's the stuff is coming up and we need to work with it, not against it. And then you'll start to feel some relief, but it's not abnormal to.
[00:43:20] Michelle: sometimes leave feeling a little blonde, a little down. Some people leave feeling really like light and happy too. Yes, I agree. I thought the same thing when I did EMDR that I was going to leave and I was going to be fixed and I was not, so how often are followup sessions after that initial session are the, and how many psychedelic sessions are there?
[00:43:41] Michelle: And I know you mentioned integration. And so how many integration sessions usually are there? it's really variable. I don't know that there is like a standard. it's kind of set by your therapist. So I'll say in my opinion, there's two different things to take into consideration.
[00:43:58] Michelle: If they're only working [00:44:00] with me or if they're coming from another therapist to do this treatment with me and then go back to their primary therapist. So obviously they would be seeing me for more sessions if it was just me. But the hope is that. psychedelic therapists like myself want to work collaboratively with other therapists that they can refer their client to us.
[00:44:21] Michelle: And in that case, I would say at least two to three prep sessions, a dosing session, and at least three integration, the integration, I can't stress enough that three would not, I don't feel like three would be enough if you don't have a primary therapist that you're returning to.But also with ketamine specifically, there are different suggestions about how often to dose.
[00:44:50] Michelle: I know a psychiatrist near me really prefers when possible, to do two treatments three weeks in a [00:45:00] row. And that's a lot. It's a big commitment because a lot of times these sessions are three hours long. you need someone to drive you to and from the session and you probably should clear your calendar for the rest of the day because who's coming out of such a sensitive state and then going back to the workplace or taking care of small children.
[00:45:19] Michelle: So it requires a lot of time off work and logistical planning. Insurance isn't really covering it yet, at least around where I am. so there's a cost factor. But, when possible, to get a really condensed treatment like that, that's two sessions a week for three weeks in a row, you can really, condense the treatment a bit.
[00:45:41] Michelle: Not that that's any better, I think that the theory is that you're working with this neuroplastic state of the brain, and we're optimizing that by,staying on top of it without overloading it. But if that's not accessible or feasible for somebody, you can still have benefits from one treatment.
[00:45:58] Michelle: You can have benefits from [00:46:00] doing it once a week if that's easier to just like take a half day on a Friday. so there is flexibility with it and you could still get great benefits. That's amazing. Well, thank you so much Michelle for coming on and answering so many questions about a topic that I know I had a lot of questions about and I'm sure the listeners did too and we'd love to have you back.