Advanced Topics in Psychedelic Therapy Integration Sessions (PART 2) – Keith Kurlander & Will Van Derveer – HPP 125

SPEAKERS

Keith Kurlander, Dr. Will Van Derveer

 

Keith Kurlander  00:08

Thank you for joining us for the higher practice Podcast. I’m Keith Kurlandera with Dr. Will Van Derveer, and this is the Podcast where we explore what it takes to achieve optimal mental health.

 

Dr. Will Van Derveer  00:28

Yeah, and we seem to be fascinated with characters, let’s say, in social media and our culture that over, you know, from our judgmental mind over indulge and hedonistic pleasure or over consume, or they’re over, maybe sexualized or over, whatever. And we’re fascinated by these people.

 

Keith Kurlander  00:53

Yeah, yeah. And, you know, I think psychedelics are gonna, it’s gonna, again, they’re going to amplify something inside of us that we often are avoiding. That happens a lot with psychedelics, and maybe we’re avoiding pleasures, maybe we amplify pleasure just because that’s what happened that day, and we’re not avoiding it. But then we discover we can contain pleasure that well, of course, there’s the experiences on psychedelics, where you have mystical experiences that are very pleasurable, and it’s no big deal. And like, and the integration is just like, this memory, where it’s just like, that was amazing. And there isn’t a ton of, you know, deep, you know, dealing with the integration because it integrated itself. I mean, that’s the other thing, I think important to say is that there are tons of parts of our journeys on psychedelics that it integrated, like, we don’t need to rehash it over and over and over like it, it did its thing and integrated, it sequenced in our body. And that happens all the time also. I think that’s important to note.

 

Dr. Will Van Derveer  02:01

Absolutely, yeah. Yeah, I mean, it would be kind of hard to get behind psychedelic therapy, if you had to keep re-integrating the lesson over and over again. If you weren’t getting traction, or, or making progress in becoming more whole, more flexible, more capable of facing and experiencing your life, you know, you’re more confident to deal with life’s challenges, it wouldn’t make any sense.

 

Keith Kurlander  02:30

No and especially if you had to rehearse a whole six to eight hour session for the next year. That wouldn’t make sense, either. So there is a lot of integration, that, you know, we talked about integration as this thing that happens after and that’s, that’s what we mean by integration. But there is integration happening during the session itself, like we are integrating aspects that were not integrated inside ourselves during the session, you know, that the medicine is actually working with us in that way. And that’s happening. And that’s the beauty of these medicines. But then there’s sometimes you know, some leftover material that needs some more work often, right? Because so much is happening a lot of the time or so or nothing is happening, which is the zone level of integration.

 

Dr. Will Van Derveer  03:23

Yeah. I mean, there’s always something happening. And we sometimes call it nothing. But yeah, you know, we have names for certain things. But I think it would be good to talk about some of the common things that need to be integrated, you know, in the days and weeks that follow a session. I mean, one of the big ones that I saw a lot as an MDMA therapist, and in the clinical trial I was involved with with MAPS was negative self image or negative self talk or just the, you know, deeply defeated, kind of protected identity that comes from carrying trauma in your system for decades.

 

Keith Kurlander  04:08

Let me ask you a point of clarification. Now, is this the negative self talk that happened during this session? Or is this like a rebound where there was positive self talk during the session, and then there was negative self talk after?

 

Dr. Will Van Derveer  04:21

It’s the rebound is what I’m referring to.  Yeah, because with MDMA, people often, I’m glad you asked that, oftentimes will have a huge shift in their perspective about negative self talk and negative image. There’s often massive forgiveness for the ways that we had to deal with avoiding flooding and dissociation that are you know, so common in chronic PTSD and in the morning after there’s especially in the beginning of the work, there’s almost always there’s a rebound of that was just the chemical talking or, or I opened up too much. And now I’m ashamed of what I shared with these people that I barely know, because the oxytocin, you know, makes you trust people more quickly and so much opening and so much self love and forgiveness often that it’s beyond the scope of what that person’s identity or their ego is really used to feeling at all.

 

Keith Kurlander  05:15

Okay. Yeah.  What was your sort of, I know, it’s always unique with every individual, but with this sort of theme of okay like morning after, days after rebound and to very negative self talk shame. What’s sort of your view that you’re holding with the client in those moments? If you’re going to share a view, what view are you typically sharing with them?

 

Dr. Will Van Derveer  05:53

Well, I guess the frame that I have found really helpful and in those conversations is this frame of parts work and internal family systems where the rebound effect of negative talk could be looked at as one part of the person coming in to protect the vulnerable parts from the risk perceived around not judging oneself, you know, judging oneself is a form of self protection. And to give that self protection up is a risky endeavor. So looking at which parts need to be protected, looking at which parts are doing the protecting, looking at how the whole system is either communicating between the parts or not, usually not, really helps knit the self together. And that’s a big part of the integration process is seeing these parts that have functioned more or less in isolation from one another to come into more of a teamwork kind of effect, which is kind of like big oversimplification of a very complex process but so I think parts work is really useful in these more cognitive integration pieces.

 

Keith Kurlander  07:17

Yeah, I think that’s great. I mean, that’s where I would take it, this parts work, I think it’s really helpful with this particular type of piece where a part comes back online, waving the flag and saying, like, I am not going anywhere. Yeah.

 

Dr. Will Van Derveer  07:35

Yeah, wait, this person really is a piece of shit. And by now it’s true. Right. And, and so, you know, Dick Schwartz, his method is really important and useful in these situations where in his language in exile, or a part of us that we have vanished, usually, because they’re very wounded, is perceived to need a really harsh protector, often to, to keep it safe. So these polarizations inside the self, don’t allow for a lot of flexibility in the way that we encounter new situations. Right. Yeah. So it’s part of the process and that could take days, weeks, months, years to integrate.

 

Keith Kurlander  08:23

Yeah, yeah, absolutely. I mean, having such a big opening, right, from a part that has been so, well, there’s different parts here. But the part, let’s say, the protector part that’s, you know, angry and whatever it is, yeah, it could take a long time to integrate it. And when there’s this opening, and the other parts start speaking up, it’s pretty amazing. And the self starts appearing and it’s powerful. Well, let’s talk a little bit about integrating this a little differently. Integration might not be the best word, but it comes up in integration. That’s an important topic so you see this emergence of psychiatric symptoms. Let’s just talk about more, you see an emergence of some bipolar symptoms, and somebody right. And I think that this is usually more common in younger people, because you know, they haven’t. People that are older usually have the symptoms already throughout their life. Let’s just say this is more common. When we see these sort of young college students coming in or somebody then they’re younger, and they’re like, to a psychedelic, and then we see this emergence of some bipolar symptoms. And I’m just curious how you relate to that as a second, how you have related that as a psychiatrist and what you would say to that person, as part of their integration of what just happened.

 

Dr. Will Van Derveer  09:47

Yeah, I mean, the first thing that comes to mind and experience of a head like that is, let’s hold off on taking another dose of that psychedelic while we sort through what happened here.

 

Keith Kurlander  09:59

Right?

 

Dr. Will Van Derveer  10:01

It might sound obvious, but college students often don’t think that way. You know, psychedelics taken in a recreational way, I think a lot of people relate to them in almost as if while I was just going to smoke a bowl, or I was just going to, you know, drink alcohol, but I decided to take some LSD instead, like, that kind of mentality is, is I found really, really common, actually, in young people. So that’d be the first step is let’s press pause on that and let’s try and sort through. And, you know, in a young person, I’m also concerned about, is there an emerging bipolar disorder? Or, you know, what is going on here? You know.

 

Keith Kurlander  10:50

Right.

 

Dr. Will Van Derveer  10:51

You know, in more extreme cases, if there’s, somebody’s up for two or three days in a row, like, I’m probably going to treat them with medication for a manic episode and doesn’t necessarily mean it’s a bipolar diagnosis, it could be a substance induced manic episode that, you know, never occurs again, but doesn’t mean I’m not going to be aggressive about treating it and helping them get their feet on the ground.

 

Keith Kurlander  11:16

Right. Yeah. So it’s sort of like psychiatric first aid for, you know, some intense psychiatric symptoms that appear trying to wrap our heads around. Is this just gonna go away? Or is there something that has been here a while, like the sleeper that, you know, I was told, right?

 

Dr. Will Van Derveer  11:39

Right.

 

Keith Kurlander  11:41

Yeah, yeah.

 

Dr. Will Van Derveer  11:42

Yeah. And I think that’s that diagnosis of substance induced mania is not maybe recognized enough? I think we tend to think, in this more traditional perspective, you talked about from 1994, that this is a person who has a mood disorder, and the substance just revealed it as opposed to, okay, well, what was involved? You know, was there cocaine involved? Was there, you know, these stimulants that really, in a recreational setting someone could be using four different things at the same time. Yeah.

 

Keith Kurlander  12:19

Yeah. Well, the other thing I have seen with people that have these sort of episodic issues, like, I mean, usually, it’s not a sleeping giant, like for me, or like, usually, you can see the symptoms and a person’s past, once you start doing your assessment. It’s just like, they’re a little more exacerbated right now. But it’s not like usually for a person that actually has an issue that they’re going to have for a while that really needs to be worked on as a psychiatric issue. Like it’s not, it doesn’t usually appear out of nowhere. In my experience, like when you do a good thorough assessment, you see a lot of different symptoms, usually over the course of a person’s late adolescence or in different places.

 

Dr. Will Van Derveer  13:02

Right.

 

Keith Kurlander  13:03

Yeah. Yeah. And then, and then if we switch gears a little, you know, I think something very common is integrating childhood trauma, right? Like that is very common. Yeah. And that, that, you know, we can look a million different ways about how the course of that unfolds I think it integration. And a lot of times, you know, sometimes people are remembering very explicit memories from childhood that they need to work through. And a lot of times, there’s just a ton of implicit somatic experience that’s very challenging to people that they experienced on their medicine, and then they need integration around, and they’re still feeling it, like it’s not, doesn’t like shut off, or a lot of, you know, a lot of people they did do a session and then like, they’re getting in touch more with a somatic experience that’s always been in their body. Because it’s, you know, but it’s been dissociated from.

 

Dr. Will Van Derveer  14:00

Exactly.

 

Keith Kurlander  14:01

And then now it’s here, and then you just feel it, and then you feel it, and it doesn’t go away.

 

Dr. Will Van Derveer  14:06

That can panic people when they’re having an ongoing, so-called negative somatic experience after a psychedelic and you know, you can start asking yourself, Is this how I’m going to be from now on? Is this the rest of my life? And that’s where the skillful integrator can help you sort through that. It’s so important. Continued sequencing the somatic experience. So it’s not stuck in some kind of semi digested way.

 

Keith Kurlander  14:38

Right. Yes, I think that’s a very common thing in integration that needs to get addressed. And I think validation is very important there, of you know, normalization is so key of, you know, we don’t know what you’re likely experiencing an old feeling that has been there with you and it just needs to be worked through, and that happens, people work through these things all the time. I think normalization is very important for someone, especially if they’re naive, psychedelic, might even haven’t done psychedelic therapy yet. And then all of a sudden, now they’re like getting in touch with core pain that they ‘ve been a ghost that’s been bothering them their whole life, but they haven’t been able to feel it in their body fully. Oh, yeah.  Yeah.

 

Dr. Will Van Derveer  15:26

Yeah. And then they’re also the folks who consider themselves to be psychedelic, maybe psychonauts, or people who have experience with psychedelics and think, Okay, well, I’ve done a lot of work here on a psychedelic, and therefore, I’m not going to get destroyed by my next psychedelic experience. I’m speaking from, I’m remembering this occasion. I’ve shared this with you before where it was almost six years ago that I got trained in ketamine therapy. And at the training, I went to the facilitator and thought it was a good idea to give 1.5 milligram per kilogram dose, IM. So intramuscular shot for two days in a row. I would never sign up for a training like this, if I knew then what I know now, but that’s what I signed up for. And it produced a very challenging integration period for me where I was very fragmented, we should talk a little bit more about fragmentation, maybe but I went into this state of deep fragmentation where everything was overstimulating. The lights and the noises in the environment I was in were way too much for me to tolerate. I couldn’t really gather my thoughts very well, I was on my way to a conference, I was on my way to the MAPS conference in California. And when I got there, I was still very affected. And but to your point about normalization, this is what triggered the memory for me is I started telling people in the MAPS community what I was experiencing, and I had people say, oh, yeah, you know, I, I did X, Y, or Z, psychedelic, and I was out of my mind for six months, and I came back and I’m a normal person now and all these ego death experiences came forward. And it actually helped me a lot. It helped me a lot to know that, because I was starting to get scared that, you know, maybe I broke my brain or, or something like that and so it was really, in some ways, a big blessing, even though I felt very vulnerable not being at home. It’s a big blessing to be around so many people who know a lot about integration, and about these overwhelming states and didn’t, I didn’t meet one person who pathologized my experience.

 

Keith Kurlander  18:02

It’s interesting, right? Because you can, let’s say you get really fragmented like that, right? And if you go to a psychiatrist who isn’t up on, or psychotherapist too who isn’t up on psychedelic therapy, like, they’re just going to hit you with dissociative spectrum disorder stuff like you’re well you’re having derealization and depersonalization. And that’s, that’s extremely painful and uncomfortable, and whatever, like, philosophically, you are probably I was, you were depersonalized. Right? That’s, that’s the issue. You couldn’t locate yourself.

 

Dr. Will Van Derveer  18:36

Right.

 

Keith Kurlander  18:37

That’s what’s so painful, right, you can’t locate oneself, or you overly locate yourself is another aspect of depersonalization. And that’s really scary. And yeah, it does integrate, you know, for I mean, I haven’t seen someone that never came back from that type of fragmentation.

 

Dr. Will Van Derveer  18:57

Right.

 

Keith Kurlander  18:57

And like you said, like, my experience has been that coming back from those places and seeing people come back, like usually, there’s like this huge teaching that comes out of it for a person. There’s some real material that comes out that’s more growth oriented, as the integration of those parts come back together.

 

Dr. Will Van Derveer  19:15

Right. Right. I mean that’s what is meant by this kind of adage in psychedelic therapy, that the harder experiences are often the most fruitful in the end. For me, I, you know, was integrating that experience for probably at least a year with my therapist, when I got home and I arrived at a much deeper understanding of some very core things about myself and my personality that was really useful. And there are, you know, going back to what we said earlier about folks who probably are not in a good position to take psychedelics, especially Not in a medical setting? You know, I certainly have had, I’ve had patients who young people who overdid it with any number of substances, and a handful of them, were not able to integrate, and, you know, remain in, in chronic mental illness, I’ve seen that. But I never ascribed that to the psychedelic did that to them, they ascribed it to, these are people with the sleeping giant that might have been accelerated and waking up, but it wasn’t like an injury from the psychedelic from my perspective.

 

Keith Kurlander  20:37

Yeah, well, you know, I think one thing that’s really interesting about very challenging big experiences, particularly fragmentation, or sometimes the integration is learning when to say no, like, you know, what, I know myself, and actually, that dose is not right. For me, it’s too much for me, because that’s where it sends me every time. You know, I remember there were students in our program that asked, like, hey, like, what happens every time to this client every time. Like, they’re just having this huge ego fragmentation, it takes months to read, and then they do it again. And they think that the path to freedom is to be able to not fragment. This question is the path of freedom to just keep going and going until I stopped fragmenting. And I think that that is a, you know, in some medicine communities, they say, just take more medicine, just take more medicine. And sometimes the integration is learning about oneself and being like, you know, what, constitutionally, with your soul, metabolize whatever it is, that’s too much for you. And maybe those medicines are even right for you. Because sending yourself into fragmentation over and over and over in your life, where you’re basically always living in fragmentation, that to me, that’s not integration, that’s not an integrated way of being in the world. Actually, you’re promoting, you know, a disintegrated way of being in the world. So I think, you know, when it comes to fragmentation, sometimes you also have to know when to say no, as part of the integration process, or if that’s the provider, even giving that feedback of saying, like, I think the answer here is to stop doing that, like you said, with the, you know, some chronically mentally ill people, and then they’ll, they’ll keep taking psychedelics. And it’s not the cause of the mental illness, but it sure makes it a lot worse. You know, I definitely, I didn’t treat a lot of people with schizophrenia, but I treated enough that we’re doing psychedelics, and it was definitely making them worse. And I was like, I can’t even work with you, because you’re doing psychedelics. And you’re so fragmented, right? And you’re so psychotic. And like, and I’m not saying that, you know, but always leads to more psychosis or whatever. Like, there’s obviously a lot there. But it’s just, sometimes it’s about saying no, and integration, like you’re learning your own boundaries around how you work with yourself.

 

Dr. Will Van Derveer  23:00

Right? Well, there’s this important concept of the window of tolerance and what level of challenge we can experience to grow. But then there’s another level of challenge that’s destructive, right? It’s like, you know, how much weight can you put on your back? There’s a certain amount that causes you to get stronger, and there’s a certain amount that will break your bones. Right? And why would we think that we should just keep going back until our bones don’t get broken? Right? Doesn’t make sense.

 

Keith Kurlander  23:41

Yeah. I mean, there’s too much of anything in the world. And, obviously, you know, whether it’s psychedelic therapy or weight lifting, like you can strain your body to where you injure yourself. Sure. And it just takes a really long time to repair.

 

Dr. Will Van Derveer  23:57

And sometimes it’s tough for the individual. To see what you’re talking about, you need to have someone else point that out to you. Hey, I want them particularly

 

Keith Kurlander  24:10

with psychedelics, it’s tough because a lot of people who are in dark places, they want some help, like there’s, you know, they generally want to get better, and the road to seeing through the puzzle of how to get there. You know, it can get very confusing and you might think like, Okay, I just keep doing this thing, and it’ll actually get me through it even now. Each time I do this, I feel worse, but I trust that it’ll get me through it and sometimes that might even be true, right? So it can get very tricky, but that’s why I think it’s so key to have good educated people around reflecting what they see.

 

Dr. Will Van Derveer  24:55

Right, or to have good friends who are willing to have difficult conversations. So with you there, and then you know not not all substances are created equal in this regard, either, you know, I think about so many folks I worked with here in Boulder who had chronic psychotic psychosis, schizophrenia, where, you know, cannabis clearly unraveled them and made them worse chronic misuse. And like you said, there’s no, it’s really difficult to have a conversation about, look, I see you falling apart, I see you not taking care of yourself. And so sometimes it takes a circle or a community of people to say, hey, let’s take a look at this, you know,

 

Keith Kurlander  25:49

Yeah, and sometimes it’s not even as severe as psychosis, right? Like, I’m just thinking over the years, like, there are people where it’s just like, you see them turning to psychedelic therapy, or psychedelic medicines. But like, you notice the pattern gets stronger, the thing they’re trying to avoid, and they can’t see it, because they’re turning to like, they don’t want to take responsibility for dealing with the pattern. So they like having a big experience with psychedelics. As like, you know, that’s another aspect of integration, right, which is like, you can actually use psychedelics as an escape from you can you can fool yourself and use psychedelics as a place to get relief from the thing you don’t want to just go deal with in your life, which might be overwhelmingly challenging. So there’s so many nuances to any, you know, medicine. Yeah, I mean, I mean, how many people are using antidepressants to escape from their problem and not actually ever deal with their problem, and they just feel a little better on the medicine, right? Like, and I’m not knocking antidepressants, it’s not like there’s not a time in place. But you could use any medicine as a place to just get relief and never change the problem. You could do that.

 

Dr. Will Van Derveer  27:04

Well, I want to honor the psychoanalyst, who I saw, you know, when I was a resident, who told me that anything could be used as a defense for anything, you know, anything, so to speak good for you can be used as a way of not avoiding a way of avoiding your life.

 

Keith Kurlander  27:25

Right? Yeah, anything could be now the nice thing about psychedelics, they tend, more often than not, to find a way in there, whether you like it or not, and show you the process. But, you know, you can use things for any reason. I mean, you know, we’ve seen we had, you know, patients over the years that were psycho knots that we’re not dealing with their life, and they weren’t doing I mean, the big key is they weren’t doing psychedelic therapy, it’s a lot harder to pull that off with psychedelic therapy. So you’ve got a therapist in the area. And the whole point of psychedelic therapy is not to be taking psychedelics all the time. Right. So that happens more in the recreational space.

 

Dr. Will Van Derveer  28:03

I agree. I’ve met a number of people who had, you know, years and years of recreational psychedelic experience that when they first go for a psychedelic therapy experience, they will tell me like, holy cow, this is not the same compound, it’s not the same experience. It’s like, there’s this, you know, it’s like one of those statues with two faces on it, or like, one’s happy and one sad, like, there’s these two phases of a psychedelic where it’s really different, it’s really, really different. Yeah. And it’s the intention and set in settings, the whole nine yards.

 

Keith Kurlander  28:41

Absolutely. Well, should we wrap up here? Any last words?

 

Dr. Will Van Derveer  28:47

I think that, you know, we, the human journey is long and for many of us, is probably for some of us.

 

Keith Kurlander  28:57

We’re the fortunate group, it’s long.

 

Dr. Will Van Derveer  28:59

Yeah. And we encounter a lot of different challenges along the way. And, you know, there’s sort of like this background observing, judging part of us that is always got an editorial commentary about our experience. And I think, I think for a lot of us it, it takes the form of like, Why Am I Suffering again? Or why am I having another hard day? Or? Why is this so much harder than I thought it was gonna be? I think that’s one of the important things that we face in integration in our lives is this, this voice that, you know, thinks it knows what our life is supposed to be like, and usually thinks it should be a little easier than it is.

 

Keith Kurlander  29:47

Right? Usually it does.

 

Dr. Will Van Derveer  29:51

That’s one of the benefits of difficult experiences that can really undermine the authority of that part of us.

 

Keith Kurlander  30:01

Yeah, I mean, most human beings somewhere inside of that believe there’s never supposed to be a challenge. Yeah, topic. I mean, I mean, most people could relate to the fact that why do we keep getting surprised when we get challenged? Exactly. I mean, I’m talking every time I mean, a trigger is inherently, everyone gets triggered. At some point during the week, you get triggered emotionally about something, which means you’re surprised you’re gonna have that challenge again in your life, you think that it should never happen again. So that’s not going away. The only people that have a claim to go over that are enlightened people, and I don’t believe them. I think he could actually transcend knowing that’s happening. But I think it’s still happening. I think it still happens in the emotional system. Maybe you can shut it down within a second. But it’s still holding you to transcend that completely.

 

Dr. Will Van Derveer  31:01

Yeah, I think it’s a matter of maybe how quickly we can remember our sense of humor about that whole. Yeah, you know, sequence of events.

 

Keith Kurlander  31:11

That system. I’m still stuck in getting surprised every day. So.

 

Dr. Will Van Derveer  31:17

Yeah, me too.

 

Keith Kurlander  31:18

Yeah. All right. Well, let’s end there.

 

Dr. Will Van Derveer  31:20

Thank you.

 

Keith Kurlander  31:21

All right, bye. We look forward to connecting with you again on the next episode of the higher practice podcast, where we explore what it takes to achieve optimal mental health.