Advanced Topics in Psychedelic Therapy Integration Sessions (PART 1) – Keith Kurlander & Will Van Derveer – HPP 124

SPEAKERS

Keith Kurlander, Dr. Will Van Derveer

 

Keith Kurlander  00:08

Thank you for joining us for the Higher Practice Podcast. I’m Keith Kurlander with Dr. Will Van Derveer, and this is the Podcast where we explore what it takes to achieve optimal mental health. Hey, everybody, welcome back to the show. So today, Will and I are going to have a conversation about integration for psychedelic therapy and a lot of the nuances involved there. And it’s both a personal interest of both of ours, we’ve been talking about psychedelic integration for a very long time at this point, way before IPI had a program, right. We’ve been talking about this stuff for probably a decade. So this is a fun topic for us. And you and I both have had a lot of, we’ve seen a lot of clients in the course of our career where we were probably doing psychedelic integration before, there was even a term floating around that much, because we saw a lot of people coming into our practices that had psychedelic stories like college students and different things. So there’s a lot to talk through here, right?

 

Dr. Will Van Derveer  01:24

Absolutely. Yeah. Yeah, it’s an important topic. And as you said, it’s more in the news or more in the conversation amongst people involved with either psychedelic research or, or ketamine assisted therapy now, but as you said, it’s been going on for a long, long time. Arguably, it’s been going on for 1000s of years, before anybody knew it, right. But yeah, it’s a key aspect of getting the most out of a psychedelic therapy experience, or a religious psychedelic experience for that matter.

 

Keith Kurlander  02:01

Right? Well, you know, this topic started for me, as you know, when I was 19, and I had a psilocybin experience that rocked my world. And I went to talk to psychiatrists about that, because I was pretty messed up after. And that was actually an integration session that no one had any idea what was going on there. And, you know, of course, you would have had to find, you know, a needle in the haystack at that point in time in ’97, no, sorry, ’94, that was 1994. So needle in the haystack, to find a person that could have helped me integrate that properly in 1994.

 

Dr. Will Van Derveer  02:50

I’m curious what did the psychiatrists tell you about that meeting, in 1994? I’m so curious what was said there?

 

Keith Kurlander  02:57

So what was sad was, what is sort of the old, an old view on this stuff, which is, Oh, it sounds like the psychedelics woke up something that was sort of like, they didn’t use the word psychotic disorder, but basically, like, woke up a sleeping giant around mental illness. Now, they were partially right, in that it woke up a trauma giant, but that’s not what they were meaning. They were meaning like, oh, it looks like you know, it kicked off a big, you know, mental illness issue here. And, you know, I saw two differences, I saw a pharmacologist and a psychiatrist. Pharmacologist was more on the psychosis train in his head when it woke up. And the psychologist was more in the Not Otherwise Specified every disorder problem, which was closer to the real issue. But it was more of a manic depressive thing when they didn’t know that. Paxil was an issue with that. So he started me on Paxil. But the first psychiatrist started me on Risperdal. So he was more on the psychosis train in his head. So they were like, Oh, you had something already, kind of you, you had an issue that was kind of at bay. And, you know, the psychedelic, but it was more like mental illness, versus like, a trauma lens, obviously, back then. So, you know, that was sort of a view back then, like psychedelics could, you know, maybe have schizophrenia and the psychedelics kicked it off kind of thing. And, you know, that was kind of the view back then.

 

Dr. Will Van Derveer  04:44

Well, and it’s still the view. I think it’s a prevailing view, right? At this point in time, and, you know, for me as a psychiatrist, I was blown away when I first came across the notion of a spiritual emergency or spiritual emergence, as opposed to, you know, everybody having a psychedelic or sorry, everyone having a psychotic experience is having a psychotic disorder. That was a really new or even like Kundalini overwhelming Kundalini rising experience. I didn’t know anything about any of that stuff as a psychiatrist, right. And I’m curious if you feel like that old perspective from 94 that you received, of, okay, you’re waking a sleeping giant of serious mental illness. Do you think that’s always wrong at this point in time? Like, what’s your view on this point?

 

Keith Kurlander  05:42

I don’t think it’s always wrong. I think that, my view on that is you’ve got contraindications for some of these medicines. You know, it’s like, someone whose dad has bipolar propensity, it’s like, you don’t really want to give them a lot of MDMA. Right. So you’ve got these contraindications going on. And I think that that was psilocybin, that journey, right. And, you know, my particular brain has this sort of bipolar propensity to it. And so I think that it’s not entirely wrong. It’s like, I probably got into a mixed mood episode after that experience, that both has that side of my brain, but also, it also flushed and forced all that trauma up in there. And so teasing those two out, I think, is a very interesting philosophical discussion. It’s hard to do. You know, trauma versus bipolar two. That’s kind of like an interesting thing. So I don’t think it’s entirely wrong to say, well, there’s something there that it amplified. That might be like bipolar two thing. I think that’s fair. I think, obviously, we know about it can send people into mixed states and manic episodes who have that issue. So I think that’s fair. I don’t think, though, that it caused the illness. I don’t think that I don’t have the perspective that psychedelics like causes schizophrenia, or anything. I don’t think that’s fair, and that that view is out there. Right.

 

Dr. Will Van Derveer  07:19

Right. Absolutely. Yeah. Yeah, I’m with you. I think that there are situations where I would very strongly discourage someone on a medical basis, not to I mean, there’s the legal basis right now, which is schedule one and all that, but on the medical side, discourage particular people with particular family histories or personal histories, not to use either a traditional psychedelic or MDMA. But yeah, I’ve, I guess what’s happened for me in my perspective is, I see that there are people like that, but then I see all these other people, maybe the majority of people who have a difficult experience with a psychedelic, I don’t look at them as having an emerging serious mental illness anymore. Some of them I do, for sure. But most of them seem to have some kind of tap into a really deep level of either personal or collective trauma that they’re working to integrate, which is kind of what brings us to that conversation for today about

 

Keith Kurlander  08:21

integration

 

Dr. Will Van Derveer  08:22

integration, right?

 

Keith Kurlander  08:24

Well, you know, you’re bringing up another aspect for me, which is, when I think back to that experience, which did for me instigate a bipolar two type episode, I mean, that that’s fine. But it also brought up a lot of implicit trauma in that session. But one thing that’s interesting you’re bringing up for me is can somebody leave a psychedelic session and have PTSD from the psychedelic session itself? And actually, I’ve experienced serious PTSD from the psychedelic session, and I’ve gotten back and forth on this, but I actually think you can, you can definitely get so overwhelmed, and have no support around it in the psychedelic experience and have no support to integrate it. It definitely could feel traumatic and the nervous system can go into traumatic responses without the right support. So I would say it’s another aspect of what I took away now from that experience is like that personal experience for me it instigated a mixed mood episode, it surfaced a severe amount of complex PTSD on a somatic level from childhood and I actually had PTSD from the session itself, when I was there alone in my room and just being flooded by all that. And I actually had to deal with that integration too of just being like that was terrifying. And being, you know, kept seeing the visions of that night with no one to integrate that with me because they had no clue what was going on. So I would say all three could happen.

 

Dr. Will Van Derveer  10:06

Right? I mean, I think that there’s a tenderness and a vulnerability of being on a psychedelic that is different by nature, just from what we know about what’s happening in the brain on a psychedelic, that’s different in nature, from the vulnerability that we carry around all day, every day where we could experience a traumatic event, and it could leave a PTSD imprint on us. So I agree with you, I think there’s a unique vulnerability there. And certainly, you know, you and I have both seen our fair share of patients who had PTSD from taking a psychedelic in an unregulated kind of unsafe environment. I remember a couple of people I treated who took psychedelics at a music festival, and, you know, got really scared because something came up, and then got really paranoid. And then it had an interaction with the police. And, you know, it just gets really gnarly, sometimes, yeah, for people, sadly. But I think it’s important, because it’s really under-represented this issue that psychedelics, I’m seeing this more to the general listeners, not so much to the psychedelic clinicians who listen to this show, but you know that psychedelics are amplifiers of what’s in your mind. And so you are going to encounter things that your conscious mind doesn’t want to know. Now, that doesn’t always happen. Sometimes people have euphoric, you know, whatever experiences that are beautiful. But more often than not, there are things in our unconscious mind that are scary, that haven’t been digested, that come up, and this is not regarded as a negative event, this is regarded as an opportunity for healing. But obviously, if you’re not in a healing setting, it’s going to be pretty hard to have a healing experience. Right.

 

Keith Kurlander  12:15

Yeah, I mean, during the experience, for sure, yeah. You know, setting matters a lot. You know, what might be useful here. So this because this is about integration, so that what might be useful for us here, we just named we talked about three things you wouldn’t might need to integrate, which is like, okay, let’s say, you weren’t really the best, you weren’t really well suited to take that medicine because of you’ve got certain issues going on psychiatrically so then you get to integrate that issue, right, of like, sort of this bipolar type episode starts happening. Or then you also have the, you know, the complex trauma that you face, that’s integration, then you have, maybe you have direct trauma, you experienced the night on your medicine, with a police officer, whatever, these are all integration issues. These are all issues of challenge, right, that happened on psychedelics, a lot of other different things could happen, it could be you had an ego dissolution, right, you could have like a spiritual experience that was very challenging and scary. Fragmentation is a whole piece of that sometimes where your ego is now experiencing fragmentation. So this is like spectrums of like, things that you might be integrating childhood insights that need to be integrated. And then there’s like, the whole spectrum of beautiful things that need to be integrated sometimes, like you experienced euphoria, for the first time in your life, right? Or ecstasy. I don’t mean MDMA, but you experienced an ecstatic experience that epiphany, right, and those need to be integrated too sometimes right?

 

Dr. Will Van Derveer  14:06

Absolutely. Yeah, I think you’re speaking from the perspective that I agree with, which is that positive and negative experiences can both stretch us in directions that we’re really not used to. And too often, I think, sadly, too often people kind of the rubber band snaps back the next morning or the next day or the next week. You know, and the conscious, maybe more defended mind wants to reject what happened and write it off and dismiss it as Oh, that was just a drug effect or whatever. And the opportunity for this expansion or this kind of workout for the mind, to become more flexible to become more open. gets missed, gets lost. Last.

 

Keith Kurlander  15:01

Yeah, let’s start with the more pleasant experiences, I think it’s actually an interesting place to start. We just kind of covered all sorts of challenging things as obviously, it’s not exhaustive, but we didn’t talk about what integration looks like. But let’s talk a little bit about the uniquely pleasurable experiences that can happen that might need integration and why. Let’s start there. So I’m just, you know, reminded we were talking about this this morning, we’re reminded back when we were in, you know, Ayahuasca churches. And when I was down in the jungles, like, every morning, somebody, maybe it was me, would be like, I finally figured out my life. Like, I finally figured out this thing that has been bugging me forever, and I’m gonna go, and I’m going to change it. And, you know, I’m, like, so excited that I have this insight about why I kept doing this thing in my life. And now I’m gonna make this big change. And, you know, that was very common for me, when I saw the jungle, somebody coming out of the ceremony being like, I’ve had the epiphany, I’m gonna change my life. And sometimes it was radical, like, I’m gonna go get a divorce now, you know, today, you know, I’m ready, just the radical sort of change, I’m gonna go quit my job of 10 years, I finally figured it out. I’ll just say that many times when I know the people who are going through that, or myself, it doesn’t usually flow the way it sounds like the morning after. Or like, there’s, I’ve seen consequences. I remember a client of mine that came out of an Ayahuasca church session, and they quit their job the next day, and I’m just remembering, you know, months later, like that the person regretted that decision, he was having a really hard time. So just curious, if we talk a little bit about these sort of big pleasurable opening Insights, where it was, it’s like a lot of excitement coming out of these sessions, and about making a change, and feeling free, which later, can lead to regret for some people. I’m just curious about what you think about that.

 

Dr. Will Van Derveer  17:29

Yeah, I’m reminded of a Brazilian shaman I was working with for quite a while, who told us that he had a student who, after the ceremony, kind of, realized that his father had been abusive to him most of his life. But this has never been in his waking consciousness. And it had never been a conversation with his father. And then he showed up at his father’s home and just ripped his ass and like, yelled at him, and the father was elderly and had a heart attack, like on the spot. And I thought about that, as an example of what you’re talking about, of, you know, there’s, what comes up for me is this metaphor that I’ve been working with of how long it takes to change our bodies, like if we choose to take on a healthier diet, or we take on an exercise regimen, it could take a year, you know, it could take six months or a year to start to feel significantly different if we’re in a hole with our health. And I think it’s kind of similar when you think about trauma being held in the cells of the body for decades, or even multiple generations and your lineage. And now all of a sudden, the morning after a ceremony you think, okay, from now on my life is different, right? It’s like, it’s a thought pattern that hasn’t been like the cellular machinery in the, in the cells, the changes in methylation and acetylation of DNA, the changes in like, what proteins are being made the changes in like, the signaling and who we actually are on that molecular level. hasn’t had any time to unfold. Right,

 

Keith Kurlander  19:17

right. Yeah, sometimes our ideas are faster than our cells can catch up.

 

Dr. Will Van Derveer  19:22

Yeah. Yeah. It’s like when we’re working with someone who is a daily cannabis or alcohol user. And, you know, we tell them, it’s going to be a year of sobriety before you really can tell what you’re going to be like. And so, yeah, to me, it’s aspirational. There’s this amazing opportunity that comes from fracking, the unconscious with a psychedelic, you know, and then we actually need to find out how to process that, that fuel that we just fracked from the awkward For under the 100.

 

Keith Kurlander  20:02

Right? That’s a good metaphor

 

Dr. Will Van Derveer  20:05

It takes time.

 

Keith Kurlander  20:07

Yeah. And you know, from, let’s say, from a provider perspective, you’re, you’re working with the person that’s coming in super excited and amped up, let’s just say amped up. And they just came from some sessions, whatever, and they’re wanting to make big changes, you know, my perspective, from integration with that is, I always tend to say to people, Well, is it gonna hurt to take a week or two, to make sure this is what you want to do. And a lot of times in a week or two, it feels very different. For people these these big decisions, so that that’s been my kind of go to when someone has a huge idea that gets generated during a psychedelic experience, and they, you know, it’s, it would have big consequences in their life, if they followed it, I always tend to try and slow people down a little, I think it’s an interesting part of psychedelic therapy in general is to be thinking about the conversation of excitement after the session. And how the ego is not going away. Like, just because they did a psychedelic doesn’t mean they don’t have an ego. And so the ego can get excited, and the either be expecting huge outcomes, if they do some crazy thing and get very attached, like, the ego doesn’t go away. Right, the ego can get very attached to an idea. So I think it’s a very interesting aspect of integration, that we don’t always look at, like, you know, what did this just amplify that may be true for the person. But that, you know, there’s reasons for the pace still, just because they did a psychedelic doesn’t mean we shouldn’t talk about pacing, or Yeah, I just, it’s just curious to me, this aspect of it all.

 

Dr. Will Van Derveer  22:09

Yeah, it’s it’s a delicate moment, you’re you’re talking about as a practitioner working with someone in integration, not to be a Debbie Downer, or, you know, rain on their euphoria parade, but to support them to really deepen their, their roots of the experience in various ways. And I think that’s where the art comes in. You know, supporting and acknowledging and upholding the beauty of that euphoric moment or that insight without getting carried away and, and losing contact with the ground of our being.

 

Keith Kurlander  22:49

Right. And I think it’s

 

Dr. Will Van Derveer  22:51

also a decision. Yeah.

 

Keith Kurlander  22:53

And it’s an important, I mean, it’s a tricky moment, because you’re obviously wanting to trust the medicine, and trust the client, and just like, you know, just trust the process. But obviously, I think as facilitators, we, we obviously, also aren’t in blind trust of, we know human beings are working with us for a reason. And they have egos, and they need a mirror, right? To just bounce it, you know, their perspectives off of and so yeah, that’s a tricky moment. It’s a tender moment. Integration is a very tender moment in general, because there’s so much a lot of the work is in integration, we say, right, like a lot of the effect on our lives is during the integration process of like, what’s going to actually start to transpire in your life.

 

Dr. Will Van Derveer  23:39

Absolutely. I mean, 80 to 90% of the healing is integration, in my opinion. And I think it’s important to just name that when folks have been very suppressed or depressed, or they’ve been carrying trauma, and they have a release from some of that burden. It’s a really common and beautiful phenomenon to see this life force begin to sort of pop out that’s been in a hole for a long time. And that’s to be celebrated as well. And those of us who’ve been doing integration for a long time have seen this kind of rebound effect that can occur when that opening isn’t integrated in a grounded way. Yeah. And that’s extremely painful for people to come down from an unintegrated release.

 

Keith Kurlander  24:36

Right? Definitely, you know, reminding of another pleasurable experience. This is really an interesting one. I had a client, I don’t know it had to be over a decade ago, that had this pleasurable opening on a psychedelic and it was so pleasurable it led into a panic attack. And then this person I kept revisiting the experience of this overwhelming pleasure leading to a panic attack. I got to see the person years later, and it was still happening, like whatever it was every three to six months. But like serious panics, it was. So this person would be a woman, she would just be like all of a sudden getting flooded by pleasure in her body. And it was so overwhelming, going into complete and utter panic. This was a very interesting, integrated piece of pleasure. And this person came to me and it was going on for years, and was terrified of the next wave of pleasure. That’s basically how the person started with me describing I’m terrified of this next wave of blusher, because it gets so big, that I get crippled by it that, like, crushes me, and then I’m freaked out for days. So this was very, you know, have you ever heard of this before? I mean, this was pretty unique.

 

Dr. Will Van Derveer  25:57

Well, I think it speaks to what we’re talking about is that the positive experiences, quote, unquote, can also be really terrifying for the ego. Right? That our sense of who we are is, if you’re like most people, narrowly defined within certain parameters of what we can fit what we’re allowed to feel in order to know who we are. Yeah.

 

Keith Kurlander  26:18

So you know, that was an interesting piece. And we did a lot of work with somatic work. I was very curious if there was sexual trauma in there. And in this particular case, there actually wasn’t one we found. But you know, we did a lot of somatic work of just working with pleasure. And really, what was the fear of the root of the work was what was the fear of having so much pleasure? Where’s it going? What’s the biggest fear? And interestingly, my memory here is that that particular fear was about that it was leading to death. Maybe I’m gonna die. So, you know, psychedelics are very fascinating when we talk about just experiences, and then integration like that taught me a lot, which is that your pleasure could also be turned into death in a person’s mind. Overwhelming pleasure could lead to death. I hadn’t thought about that, prior to that moment. It makes me

 

Dr. Will Van Derveer  27:20

i wonder about my own relationship to pleasure. And how capable or how tolerant am I? Or how open Am I to that level of pleasure? What would that,

 

Keith Kurlander  27:33

you know? Yeah, right. I know, I don’t let him have that much pleasure. I, you know, the, this is interesting to just more ematic conversation of pleasures, like how many people let in that much pleasure. Right. Right. And psychedelics will sometimes send us there. So that was an interesting integration piece. I didn’t wait, it was cool to not have to pathologize it other than I have my moment of being like, is this have a sexual, you know, like injury and here are, but I didn’t hold on to that. But it was cool to just work with that subsided over time as we just work somatically around pleasure. So that was the integration for that person. Somatic work around pleasure. So I think the takeaway for me of that piece that really is important here is that you have to sometimes integrate pleasure as well as pain in our bodies. It’s not only just pain that is not integrated in our bodies. It’s also pleasure not integrated in our bodies,

 

Dr. Will Van Derveer  28:46

I feel like that imbalance between pleasure and pain is more and more pronounced. It seems like in our culture right now, like the idea of having a pleasurable time, this is just my own, like, hang up around pleasure, I think is, is it okay to have a pleasurable experience when so many people are suffering so severely right now? There’s a lot that comes up for me around guilt and prohibitions around displays of pleasure and enjoyment. You know, I know there’s a lot for me in my history that is connected with that, but

 

Keith Kurlander  29:31

Well, yeah, I mean, I think culturally too, you know, while this particular culture is interesting, like do we celebrate pleasure, and I mean, we celebrate in a lot of strange ways, like if you’re sort of watching Social Media for cultural analysis, do we sell by pleasure? It’s sort of a very interesting piece of how we do that, right? We’re not necessarily celebrating the pleasure in our bodies. So I think this culture, in many cultures on the planet, does a lot of negative messaging about pleasure. 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.