Ketamine Assisted Psychotherapy: Hope for Treating Depression

Ketamine Assisted Psychotherapy: Hope for Treating Depression

By Guili Zavaschi, LPC

1/1/2018

Participating as a therapist in the Ketamine Assisted Psychotherapy (KAP) project at the Integrative Psychiatric Healing Center in Boulder, Colorado has been a fascinating and encouraging journey. In a short amount of time I have seen clients having profound insights and relief from harsh depressive symptomology. In this small article I will address four themes that I have noticed and observed in my work with clients during the process of KAP.

Accessing traumatic states with support

It is a rare and valuable opportunity to work psychotherapeutically with the support of a medication that accelerates the healing process. In working with clients undergoing KAP I have witnessed and facilitated people accessing traumatic memories and repressed feelings. Clients become more easily aware of traumatic material without being as triggered or activated as they are when touching into those states without KAP. This allows for the integration of past experiences associated with their current states of anxiety and depression.

Flexibility of mind

During KAP clients tend to enter into a state that I call “mind flexibility.” Stubborn mindsets and introjected beliefs about themselves and their experience of life that create great suffering and sometimes feel involuntary and irrational can be experienced with a sense of ease and softness. Clients often begin to access a certain gentleness in which they hold their beliefs. This process can also allow them to access the memories of traumatic life events that shaped those foundational internalized messages. With KAP the pressure or threat that solidified those mind states is temporarily alleviated or eased, allowing the individual to let go and soften the grip on those beliefs. As the mind and body access a sense of ease while touching those core inner messages and traumatic feeling states, clients can find a new template for being. There can be a shift not only around how clients think about themselves, but also around how they feel about themselves and their lives in a more embodied manner.

Attachment/Relationship repair

With the help of an emotionally available, attuned and attachment informed psychotherapist, clients undergoing KAP can potentially reshape their sense of safety and capacity to be in relationship with others. While under the effects of Ketamine, clients’ brains are in a malleable state that can more easily open to a sense of “right relationship.” Clients become capable of finding empowerment through relaxation, and access the emotional availability necessary to relate to others and claim relational boundaries when appropriate. While in KAP the role of the therapist is to support the client to find a natural sense of connection, safety and access to emotion that is often disrupted in the face of relational trauma and that attachment psychology claims is every human’s birthright/natural state while in relationship.

Embodiment/Temporary ego dissolution

Another theme I have witnessed facilitating KAP sessions is that there is an experience of temporary ego dissolution. When medical professionals use Ketamine for anesthetic purposes, such as medical surgeries, the result is a complete yet temporary dissociation from the body in order to not feel the pain of the surgery. In KAP, however, the clinical dose is a fraction of the medical anesthetic dose, which allows clients to track a mild dissociation from the body that actually has the unique and paradoxical effect of intensifying an awareness of the body and invites a new kind of presence into the client’s lived experience. In this process the coping strategy of dissociation, often linked to severe depression and anxiety, starts to unwind and clients can experience their bodies in a more vital and present way. While under the influence of Ketamine the experience of being in a body changes, thoughts and feelings can seem suspended, having a personality and the way one perceives time and space become temporarily altered and there is often a total shift in ones sense of self location. Although experiences like these can be frightening, strange and confusing, with the anesthetic effects of Ketamine combined with a skillful psychotherapeutic facilitation those states can have a profound reorganizing and relieving effect. Clients can potentially have what Abraham Maslow called “peak experiences,” experiences that challenge our usual lived perceptual reality. Peak experiences can support clients to renew and expand their sense of self and connect to a sense of wholeness. Those experiences can be perceived as being spiritual or transpersonal and have the potential to be profoundly liberating.

 

 

 

 

 

 

 

 

 

The Grieving Process: What is Normal and When to Seek Help

Written by: Miki Fire, PsyD

For many people, the process of grief is one of the most challenging and painful experiences in our lives. Whether it is grief following the death of a loved one, the ending of a relationship, the loss of a job or a home, the death of a pet, or even just the experiences of loss that come with the myriad endings we face each day, the experience of grief can be overwhelming.

Grief is one of the most common of human experiences, although it can feel absolutely strange and frightening. Grief impacts us on every level of our being; emotional, psychological, physical, mental, spiritual, and social. We may experience feeling of overwhelming sadness or anger; we may literally feel like we are going crazy; we may feel like we can’t breathe, can’t sleep, can’t eat; we may feel numb and disconnected from the people in our lives; we may even feel like life is not worth living. In some ways grief itself is like a vicarious death and we ourselves feel like we’re dying. These are just a few of the many different ways in which grief moves through our systems.

Many people wonder: Is what I’m experiencing normal? You may have heard that there is a normal process to grief and that there are specific stages of grief that everyone goes through in a specific order. The truth is that when it comes to grief, there is no one defined way that every person experiences and processes grief. Some people may feel the different emotions we associate with the classic stages of grief model described by Elizabeth Kubler-Ross in 1969 (denial, anger, bargaining, depression, acceptance), but not everyone feels these exact emotions, nor do people feel them in this order or only once. In addition, these experiences only describe the emotional/psychological levels of the experience, but not necessarily all of the other ways in which grief is experienced, like for example on the physical level.

When it comes to grief, your grief process may look entirely different from someone else’s, and whatever you are experiencing is normal. Really.

People often ask, “But, do I need to seek help?” When it comes to grief, seeking “help,” can often be incredibly useful, no matter where you are in your grief process. Seeking help does not need to be seen as a last resort, but potentially an integral part of the process. Many people come into therapy feeling like they have somehow failed because they were not able to “get through it” alone. In actuality, seeking support, whether that means reaching out for the support of friends and family or seeking the guidance of a therapist or support group, does not need to be a last resort option, but can be seen as an important tool in processing your grief in a healthy way. Grief is a completely normal, universal, human experience and in this way it actually has a way of moving through our systems quite naturally, if we let it. But, most of us have lots of reasons why it is hard to just let the process do its thing, and outside support, can be useful in helping us see where we might be impeding the process and making things harder on ourselves.

In addition to using outside help to support a normal grief process, there are some additional situations in which seeking help is recommended. The following are a few of these situations:

  • If you feel that you are at risk of hurting yourself or another person.
  • If you do not feel you are able to attend to your basic needs such as food, clothing, and shelter.
  • If you feel unable to attend to the basic needs of your children, or any other people or pets that are dependent on you for their basic needs.
  • If you are concerned that the ways you are coping might be hurting you (e.g. excessive alcohol or drug use, self-harming behaviors like cutting or burning, etc).
  •  If you do not feel that your grief process has in any way changed after what you consider to be a reasonable amount of time, and you feel like it is debilitating your ability to engage in important areas of your life, such as work, relationships, etc, and you are unsure of how to move forward.

In addition to therapy, which can be incredibly helpful for processing the experience of grief, there are many different types of support groups specifically designed to help individuals in the grieving process. Groups can be one of the most effective supports for grief because of how powerful it can be to recognize that you are not alone in your experience.

 

Grieving is a process that can take a very long time. Especially in the beginning, it may feel like it will never end. As cliché as it sounds, time does heal in many ways, but even when years have passed and there is a sense that the grief has really moved through, there may still be moments where the sense of pain and loss comes flooding back; like anniversaries of various kinds or important life events. This too is completely normal, and you can trust that having been able to live through the early days (and months and even years) of grief, even in the unexpected moments when the grief returns, you will have the capacity to be with it and get through it. Although it may be hard to believe this if you are in the early stages of coping with a loss, grief is incredibly powerful in its ability to change and even transform in positive ways. The process is not an easy one, but it is a profound and universal one; it is an experience that we all go through in some way at some time, and that changes us forever.

(If this blog resonates with you in any way, or if you have any additional thoughts, suggestions or questions in regards to this topic I welcome any comments!)

 

How To Tell the Difference Between the Blues and Symptoms of Depression: 6 Tell-Tale Signs

By Sunda Friedman Tebockhorst, PhD, LPC

“The opposite of depression is not happiness, but vitality.”
This quote from writer Andrew Solomon contains some important wisdom about the nature of the beast we call depression. It is normal to experience sadness, to have days of feeling grumpy or down. We all have days like this, sometimes a few in row. It is normal to feel sad in response to distressing life events – these are the bumps in the road of life, and for most of us, we navigate over the bumps and get on with the life we recognize as ours. However, when the obstacle is not the normal vicissitudes of daily life, but rather a run-in with depression, this can be altogether a different story. Life becomes a foreign and exhausting experience, where it feels like there is no respite and no hope for a more engaged tomorrow. Here are some things to look for if you aren’t sure whether or not you might benefit from help for depression. If you have found that, for more than two weeks or so:
1. Everything is exhausting: the tasks of daily living – getting the mail, taking out the trash, doing the dishes, talking to friends or family – are overwhelming and extraordinarily demanding. If it feels like doing the little things of everyday life is just too much to face, you may be dealing with depression.
2. Everything is annoying: for many people, and this can be especially true for men, who in our culture our discouraged from acknowledging that they feel down or sad, depression shows up as extreme irritability. If you find that you are responding to the other people and events of your life with intractable bouts of extreme irritability not in proportion to the events in question, you may be dealing with depression.
3. Everything is overwhelming: you used to find that life was a pretty comfortable place for you, but now find that even minimal levels of stimulation are overwhelming for you. People in your life talk too much or talk too loud, bright colors are intrusive, any change in plans or routine is unbearable, even music, books or movies you used to enjoy demand too much energy – if this sounds familiar, you may be dealing with depression.
4. Everything is un-interesting: you used to enjoy your hobbies, had activities or events in your life that predictably brought you pleasure, but now, nothing is pleasurable or enjoyable. If food tastes bland, jokes are never funny, you don’t look forward to things you used to, you can’t seem to care what’s going on around you, you may be dealing with depression.
5. Anything could provoke tears: if you find that you cry frequently, sometimes for reasons you don’t understand, or for no reason at all, you may be dealing with depression.
6. Nothing provides relief: if you have come to a place where you feel no hope that things will change or improve, and/or you feel helpless to gain traction and return to a place where life held some pleasures, if a sense of defeat and purposelessness has invaded your daily routine, you may be dealing with depression.
It’s important to note that, if several or all of these things ring true for you, you do not have to just suffer through it. There are effective tools for managing and resolving depression, most notably, therapy and medications. Statistically speaking, the best outcomes in terms of recovery happen when we use both of these approaches together; you will have to find the specific remedy that best suits your particular needs. What’s most important is that you know that you don’t have to keep struggling and you certainly don’t have to accept that this is just the way things are. Depression is an awful monster that can take over people’s lives, whisper horrible things in their ears, and prove a relentless and formidable burden. While you may not know what to do to get rid of this monster if it has invaded your life, you don’t have to do it alone. A skilled therapist can help you move back to a place of vitality and engagement in life. Please – if this describes you or a loved one – know that we as a community of experienced therapists would like to help you begin the work of taking back your life from this monster. There is hope, and there is help. Finding the right therapist can be a great first step.

Grief and Loss in Parenting

By Miki Fire, Psy.D.
Clinical Psychologist

As a relatively new parent, I have spent a lot of time reflecting on the experience of this new role. Like many of you, my experience in parenting has come with some unbelievable moments of joy; the feeling of holding your baby for the first time, of seeing your baby laugh or smile at you, watching as your baby begins to crawl and then stand and eventually walk and run. Of course, there are all the challenges as well; trying to soothe a colicky baby, endless hours of rocking and bouncing and shooshing your little one to sleep (not to mention your own sleep deprivation), or trying to communicate to a toddler that he needs to have patience and wait a few seconds before you can give him that toy he’s reaching for. Alongside these there might also be myriad challenges in parenting alongside your partner who may have his or her own different ideas of what’s best.

Most of what we are exposed to—in the popular media, in our pediatrician’s office, in the conversations at the playground and even at most new parent support groups—are these kinds of ups and downs.

What we hear much less about, if ever, is a much more subtle experience, yet one that is absolutely felt, and that is the grief and sense of loss that is also associated with parenting. Especially in the early years of being a parent, the feelings of sadness and outright grief and mourning can be quite intense, yet are rarely discussed. Because we don’t often talk about this grief, we sometimes wonder if it’s normal, we may pathologize it, push it away, or simply keep it to ourselves

Have you ever noticed, as a parent, how painful the experience can be? How much that sense of love for your child also brings with it a sense of sometimes overwhelming heartache? How in each moment, even if that moment has been unbelievably trying, there is sometimes a surprising sense of nostalgia for that same experience once it has passed?

Why is there such a sense of grief and loss in parenting?

I think that the first days and weeks and months of parenting can be so new and, for many of us challenging, that we tend to feel primarily the relief and joy with each new development. “Ah, she is finally sleeping five hours straight! She doesn’t need to be burped every time she eats! I can put her down for a few minutes and make myself a cup of tea without her fussing!” But what we don’t always feel as strongly, at least not on the surface, is the ending that comes with each new moment, each achievement.

Not one instant can be held on to. Not one day is the same. The minute a new milestone is achieved whatever preceded it is gone, simply folded into the next movement. Your baby’s balancing on two knees becomes a crawl, then a crouch, which becomes an unbalanced stand, a first step, a walk, a run. Even with language, those little gurgles and raspberries which become babbling and eventually actual words. Once you have a child that has mastered the art of language, it might be hard to imagine that you lived with an essentially non-verbal being for a couple of years! Whatever the development, each new movement echoes some past experience, but we never go back, ever. Our tendency is often to focus on the new step our baby has taken, but we don’t necessarily say goodbye to the previous stage that has now been mastered.

Of course there will be more firsts. In fact, all there ever will be are firsts. But every first is also a last. As parents we often joke about how once you have finally mastered some aspect of your child’s development she is on to the next milestone, leaving you to have to figure out a whole new set of tricks. There is joy and relief in moving onto what is new, but there is also a sense of ineffable loss for whatever phase has now come to an end.

If we really think about this experience for a moment, we can begin to touch on the poignancy of this ongoing experience. In a way, being a parent is to witness what it truly means to be alive, as a human being. To know that each day, each moment, each breath, comes and then goes. Parenting, in this way, gives us a very palpable sense of impermanence.

And of course this reflection of impermanence so perfectly revealed in our children is true for everything. As adults we tend to not see the subtle changes that are happening; maybe because they appear so much less dramatic they are missed, easily overlooked, or even denied. Changes tend to blend into one another affording us the illusion that things are essentially the same. It may not be until we are much older, or witnessing the aging process in our own parents, that we have a palpable sense of the passing of time. But it is simply impossible to not see how quickly everything ends when you are in the presence of your child.

And for many people, this constant experience of endings brings with it a feeling of deep heartache. People may have warned you about many of the other challenges of becoming a parent, but rarely do people warn you of the bittersweetness that comes as each day comes to an end and your child is one day older. Yes, there is a deep sigh at the end of a long day, after all the toys have been cleaned up and you can finally sink into the couch with a good book. But for some people there is also a sense of loss. This feeling may be experienced as a sense of depression even. It may be felt as a general fatigue or apathy. Maybe a tearfulness that you cannot explain, or even a feeling of agitation or irritation. We sometimes talk about post-partum depression or “baby blues,” but we rarely acknowledge that these feelings of malaise may actually be normal and appropriate grief for this new experience.

Because in addition to the sense of loss that can come with watching your child change so rapidly is also a very reasonable experience of mourning that may come with the huge transition you are experiencing as a parent. There may be a sense of loss for the person you felt you were before you had children, or the relationship you and your partner had that was just the two of you. If you already have children there may be a feeling of sadness and loss that you no longer can spend all of your parenting time with your other child or children, that this energy is now shared.

We are generally told that we should be happy and grateful to bring children into the world. But rarely are we told that it is okay to also feel pain for the life we have left behind. And this life is truly behind us, even when our children are older and we can work more, spend more time with our friends and alone, it will never be the same.

A part of you may wonder, what can I do about all of this? What should I do about all of this?

Grief is an experience that many people attempt to bypass because it can often be so painful. But my clinical experience has repeatedly shown me that grief is an incredibly important experience that, if possible, is best travelled through, not around. Especially for anyone who has experienced bouts of depression or anxiety that have not lifted easily, there may be a fear that if you turn towards the feelings of sadness and loss, they may just get bigger and more stuck. When you first turn towards your grief, it may feel like it does get bigger, more poignant, or more painful. This is normal. If it is too much to be with, then let yourself turn away towards something else. But notice when you are intentionally avoiding feelings of grief. Even just this noticing is a subtle acknowledgment of the grief that might be there. Here are a few suggestions for how to be with your grief.

  1. Begin my simply acknowledging that all of the feelings you are having as a parent are completely normal. Give them permission to be here.
  2. When you notice a difficult emotion, like sadness or some pain, just let yourself acknowledge it is there. You don’t have to do anything more. In fact, with the busyiness of parenting, you may not have space to really do more than this.
  3. Find a time in the day when you can turn more fully towards whatever feelings have been coming up. Maybe this is while your child is napping, at school, or in bed for the night. During this time, just give your whole body and mind permission to feel whatever feelings may be there and have been there. Even this is enough. You don’t have to do anything with the feelings, just feel.
  4. If it is hard to just stay with your feelings in an unguided way, here are some suggestions for ways to turn towards, and acknowledge your grief: Use a journal and let yourself write openly about your grief, paint, draw, or engage in any other art form on the theme of grief, set aside 10 minutes to simply sit quietly and invite your feelings to be with you. Just by setting an intention to be present with your feelings, any activity has the potential to be a practice in more fully processing your grief.
  5. Talk with someone. A friend, your partner, a therapist. Naming your feelings can be one of the more powerful ways of working with grief. When we put words to our inner experiences it often leads to a shift in the experience itself and a deeper sense of meaning.

In essence, my suggestion is, take it all in, let whatever feelings you might have in this process be here in their complete fullness. And know that, even whatever you are feeling now will not be with you forever. Grief (unlike some clinical depressions) does have a way of moving and changing. The grief you may feel as a parent will inevitably shift as your child changes.

And remember, really being honest about these feelings and letting yourself really feel is an extraordinary gift, not only for yourself, but also for your child. You are teaching him or her that emotions, even difficult ones, are okay, survivable, and can even serve as doorways to something new.

(If this blog resonates with you in any way, or if you have any additional thoughts, suggestions or questions in regards to this topic I welcome any comments!)